The American Academy of Pediatrics (AAP) is a left-of-center organization comprised of pediatricians which claims to advocate for the medical welfare of children. Nominally nonpartisan, AAP has taken left-of-center stances on LGBT issues, gun control, and government-controlled healthcare in recent years. ^{1 2 3}

AAP has argued in support of “gender-affirming” care for transgender children, including the use of puberty-blocking hormones in pre-pubescent children. ^{4 5} The organization has also supported the expansion of government-controlled healthcare programs and is a longtime supporter of the Affordable Care Act (ACA). ⁶ Even on issues unrelated to health care, AAP has taken left-of-center positions, including calling for “the strongest possible regulations of handguns for civilian use,” an assault weapons ban, and universal background checks for firearm purchases. ⁷

Throughout the COVID-19 pandemic, AAP supported the widespread use of mask mandates and has resisted efforts to repeal them, even as COVID-19 cases declined dramatically in the United States. ^{8 9} The organization has also supported the mass vaccination of children against COVID-19, despite acknowledging that COVID-19 is rarely a serious concern for children. ^{10 11} While AAP supported the reopening of schools for in-person learning as early as July 2020, it has insisted on the continued use of masks and social distancing in schools until children are vaccinated against COVID-19. ^{12 13}

History

AAP was founded in 1930 by 35 pediatricians to promote health among American children. After its founding, 400 pediatricians were invited to become charter members. ¹⁴ Three years after its founding, the AAP created the Red Book, a publication now consistently updated online that contains information regarding infectious diseases common to children. ¹⁵

Today, the AAP has grown to include 67,000 members who operate in AAP chapters spread across the United States. ^{16 17} The organization publishes over a dozen pediatric care journals and shares information with pediatricians around the country regarding medical best practices and standards in pediatric care. ¹⁸ The AAP also engages in political advocacy campaigns. ¹⁹

Political Activity

Though AAP brands itself as apolitical, it has taken several left-of-center political stances in recent years. The AAP has endorsed left-of-center proposals for expanded government-controlled healthcare, LGBT health issues, and gun control. ²⁰

Government-Controlled Health Care

AAP has consistently advocated for the expansion of government-controlled health care in the United States. The AAP is also a longtime supporter of the left-of-center Affordable Care Act (ACA) and has opposed any attempts to reform or revoke it. ²¹ In 2019, the AAP joined a left-of-center coalition including the American Federation of Teachers (AFT) and the Children’s Defense Fund in condemning a South Carolina measure which sought to require Medicaid recipients to actively seek employment in order to maintain benefits. ²²

In November 2018, the AAP congratulated Rep. Kim Schrier (D-WA) for becoming the first pediatrician elected to Congress. The AAP expressed its desire to work with Schrier, who ran on a platform of supporting government-controlled health care, setting caps on prescription drug prices, and implementing gun control measures. ^{23 24}

In May 2021, the AAP sponsored a report by the National Academies of Sciences, Engineering, and Medicine which called for guaranteed primary care for all people on the United States, controlled by the U.S. Department of Health and Human Services (HHS). The report also called for a radical restructuring of payment systems in the healthcare field, including an end to fee-for-service models to instead adopt a system that instead addresses “social determinants of health.” The report recommended that the government also step in to reduce the rates of allegedly “overpriced” health care services. ²⁵

LGBT Advocacy

AAP is a longtime supporter of left-of-center policy on LGBT issues. In 2013, AAP came out in support of same-sex marriage and adoption by same-sex couples. ²⁶

In recent years, AAP has focused on issues related to transgender children. In 2018, AAP released a statement supporting “gender-affirming” care for transgender youth in accordance with their stated gender, rather than their biological sex. ^{27 28} Gender-affirming care calls on pediatricians to support their patients’ gender identity, including by providing treatments like hormone replacement therapy and sex reassignment surgeries. ²⁹ The AAP has also called on pediatricians to routinely ask patients, including children, about their sexual orientation and gender identity as part of primary care. ³⁰

AAP has worked to oppose efforts to restrict so-called gender-affirming care for children. Several states have sought to ban transition treatments, like hormone therapy and sex reassignment surgeries, for minors, measures which the AAP has opposed. ³¹ The left-of-center American Civil Liberties Union (ACLU) has used AAP’s stance on transgender youth to justify a lawsuit against the state of Arkansas seeking to invalidate a law that prohibits the use of hormone therapy in pre-pubescent children. ³²

Even on issues unrelated to child health, AAP has come out in support of left-of-center LGBT policies. AAP supports allowing transgender children to play on whichever sports teams match their gender identities, rather than having them play on teams with other players who are biologically of the same gender. ^{33 34}

Gun Control

AAP has claimed that gun violence is a “public health issue” and has called for sweeping gun control laws to address it. Since 2013, the organization has supported an assault weapons ban, mandatory background checks and waiting periods for all firearm purchases, a ban on high-capacity magazines, and federal handgun regulations. ³⁵ AAP has claimed that the “absence of guns from children’s homes and communities is the most reliable and effective measure to prevent firearm-related injuries in children and adolescents.” Aside from advocating for a ban on semiautomatic weapons, the organization has called for “the strongest possible regulations of handguns for civilian use.” ³⁶

AAP has also supported controversial “red flag” laws, which allow family members or law enforcement to petition a judge to indefinitely remove a firearm from the possession of a person deemed to be a risk to themselves or others. ³⁷ Critics have argued that the laws invite the abuse of power by activist judges and law enforcement by allowing them to strip the gun rights of anyone they choose, in addition to doing very little to prevent gun violence. ³⁸

AAP has called for longer, mandatory waiting periods for firearm purchases and universal, enhanced background checks, including for private sales. ^{39 40} The AAP has also lauded measures to regulate gun storage in individual homes. ⁴¹

In 2018, AAP engaged in direct advocacy on gun control issues, with 350 pediatricians going to Congress in a single day to advocate in support of gun control. The lobbyists called for an “assault weapons” ban, the restriction of semiautomatic weapons sales to people 21 or older, and $50 million in funding for the Centers for Disease Control and Prevention (CDC) to research firearms. ⁴²

Other Activities

In October 2022, Healthy Children, the official partnering website for AAP, released a link on their profile for X (formerly Twitter) asking parents if they were considering buying a cell phone for their children, with the link taking viewers to a 10-question survey part of a campaign by Healthy Children and cell phone company AT&T. ^{43 44} The survey is described as being, “developed by pediatricians from the American Academy of Pediatrics and AT&T — [and] can help you decide if you and your child are PhoneReady.” ⁴⁵ In June 2020, AAP’s publication Pediatrics released a report on how families can choose a healthy digital plan to avoid influencer marketing and sponsored content, which claimed that the best plan would be one that, “…intentionally uses high-quality media content that has as few ads as possible, limits data collection, and encourages discussion about privacy.” ⁴⁶

COVID-19

Throughout the COVID-19 pandemic, the AAP recommended restriction policies, including mask mandates without time limitation. The AAP has also pushed for the mass vaccination of children, even after acknowledging the emergence of heart inflammation in young people who received the COVID-19 vaccine. ^{47 48}

School Reopenings

Despite generally supporting left-of-center policy during the COVID-19 pandemic, AAP advocated in summer 2020 for a return to in-person learning. In July 2020, the AAP advocated for a full return to in-person learning during the 2020-2021 school year, claiming that sending student to school was “critical” to addressing “racial and social inequity.” ⁴⁹ To accompany its position, the AAP published detailed guidance for schools during COVID-19, including calling for physical distancing, the “universal use of face masks” in middle and high schools, and limits on school visitors. ⁵⁰ Just one month later though, AAP officials walked back their statements while testifying before Congress, claiming schools “really can’t open” in person during the pandemic. ⁵¹

In December 2020, AAP published a report noting that COVID-19 transmission in schools was low but nonetheless calling for continued mask mandates for students. ⁵² Throughout early 2021, AAP called for immediate school reopening for full in-person learning, on the condition that students be required to wear mask and socially distance. ⁵³ In March 2021, the AAP continued to recommend social distancing in schools, but encouraged only 3 feet of distance, rather than 6. ⁵⁴ Despite acknowledging that schools do not create community spread of COVID-19 and recommending that elementary children not wear masks in July 2020, AAP chapters have continued to push for mask mandates across public schools. ^{55 56}

Mask Mandates

Even as AAP data has revealed that students are not at high risk of spreading COVID-19, AAP has continued to recommend that unvaccinated children be forced to wear masks. Even in the wake of a study which saw no difference in COVID-19 infections between schools which required students to wear masks and those which did not, AAP continued to support mask mandates for children. ⁵⁷ Outside of the school system, AAP has suggested that all unvaccinated children over the age of 2 must wear a mask indoors. ⁵⁸

As states have sought to scale back restrictions in the summer of 2021, chapters of AAP have continued to advocate for mask mandates across the country. In May 2021, the Michigan chapter of AAP applauded Governor Gretchen Whitmer’s (D) decision to require all children over 2 to wear a mask indoors. ⁵⁹ AAP chapters in Wisconsin, Mississippi, Oklahoma, Montana, and North Dakota similarly called for the implementation or continuation of mask mandates, even as the United States saw rapid declines in COVID-19 cases in spring 2021. ^{60 61 62 63 64}

Child Vaccination Campaign

In spring 2021, AAP began aggressively advocating for children 12 and over to receive the COVID-19 vaccine. The group also encouraged pediatricians to administer the COVID-19 vaccine at the same time as other routine vaccinations, claiming that the vaccine was necessary for children to “regain their lives,” despite the fact that COVID-19 poses a comparatively small risk to children. ⁶⁵

In June 2021, AAP continued its campaign to vaccinate children even after a troubling link between heart inflammation and the COVID-19 vaccine emerged among young people. The AAP argued that the benefits of the vaccine outweighed the risk of complications from COVID-19, despite the fact that its own data has indicated that children very rarely suffer severe COVID-19 when infected. ^{66 67}

Aside from advocating for children to be vaccinated against COVID-19, AAP has expressed support for state-mandated vaccinations in other contexts. In December 2019, the New Jersey chapter of AAP testified in support of a bill that sought to eliminate the religious exemption for vaccination, forcing all children to be vaccinated in order to attend school unless they have a specific medical contraindication. ⁶⁸

People

Lee Ann Savio Beers is the current president of AAP. ⁶⁹ Beers is a professor of pediatrics and the medical director for community health and advocacy at Children’s National Hospital, in addition to working as founding director of the DC Mental Health Access in Pediatrics program. Beers has also worked as a military doctor at the U.S. Naval Hospital Guantanamo Bay, Cuba. ⁷⁰

Mark Del Monte is the CEO and executive vice president of AAP. Del Monte previously worked as chief deputy and senior vice president for advocacy and external affairs at AAP. Before joining AAP in 2005, Del Monte worked as director of policy and government affairs for the AIDS Alliance for Children, Youth & Families. ⁷¹ Since 2013, Del Monte has made 25 political contributions, all of which have gone to Democratic candidates and committees including the Democratic Senatorial Campaign Committee (DSCC) and former Secretary of State Hillary Clinton’s failed 2016 presidential campaign. ⁷²

Funding

In 2018, AAP reported $121,878,940 in revenue and $62,163,314 in net assets. ⁷³ More than half of its revenue came from its memberships, journals, and publications. ⁷⁴ The AAP also reported receiving $20.5 million in government grants and over $12.9 million in outside contributions. ⁷⁵ That same year, AAP reported $118,478,392 in expenses, including nearly $800,000 spent on legislative lobbying. ⁷⁶

AAP gains a significant portion of its revenue through sponsorships at its conferences and frequent member events, though it has received criticism for its seemingly hypocritical sponsorship arrangements. In 2010, AAP hosted a conference which featured SweetSurprise.com, a corn-syrup promotion compony, as a sponsor, despite the fact that the AAP itself advocated against high fructose corn syrup and claimed that soda consumption was associated with higher rates of obesity. ⁷⁷

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62. Martinez-Keel, Nuria. “Billboards Call for Oklahoma School Mask Mandate.” The Oklahoman. November 1, 2020. https://www.oklahoman.com/story/news/columns/2020/11/01/billboards-call-for-oklahoma-school-mask-mandate/307464007/.
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64. Biertempfel, Maddie. “North Dakotans React to Mask Mandate, New Measures.” KX NEWS. November 15, 2020. https://www.kxnet.com/news/north-dakotans-react-to-mask-mandate-new-measures/.
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