Pediatrics: Operationalizing Equity: A Methodologic Framework for Revising Pediatric Clinical Guidance

March 2026

The American Academy of Pediatrics (AAP) has been leading the field in identifying and assessing clinical guidelines in need of review and revision based on the inappropriate or inaccurate inclusion of race as a decision-making factor. This article, a special supplement to the journal, and the accompanying video, lay out the methodology developed by the AAP team to triage the wide range of algorithms and guidelines in need of review, how to assess their quality in terms of health equity, and what factors to consider in order to recommend decision tools for revision. By applying the set of criteria below, developed by the team as part of their investigation, the task force concluded the 75 of the examined guidelines required revision, while 74 did not.

Criteria

Explicit mention of race and/or ethnicity in problematic ways (e.g., as a biologic proxy or as an independent dichotomizing clinical risk-determining variable)a

Reliance on clinical evidence that is flawed in its consideration of race and/or ethnicity (e.g., eGFR, PFTs)a

Focus on clinical topics with known inequities or outcome disparities that are described in the literature, however, are absent in their mentiona

Mention of outcome disparities without discussion of drivers, etiology, or proposed solutionsb

Figures, tables, and/or images that are either not inclusive or present race and/or ethnicity in a problematic mannerb