Amid mild temperatures and windy conditions, players from ages 14-18 took to the football field at The Oaks on the Soboba Indian Reservation to participate in the 2023 Soboba Youth Turkey Bowl on Nov. 21. Steve Lopez, Assistant Director for Soboba Parks and Recreation and Harold Arres, Regional TANF Manager for Soboba Tribal TANF, collaborated on a day of fun for youth that were off school for the week due to the Thanksgiving holiday.

Near the football field, TANF staff members set up tables with art supplies for young artists taking part in the Paint Workshop being offered. They were encouraged to create a desert scape with sample ideas printed out and placed on each table for reference, but many took artistic liberties and painted different types of scenes or made their own choice of colors.

Open to all Native youth, both activities were appreciated by parents to give their children a fun and productive outing to share with friends and family. Several players came from Pala to join the flag football game. After warmups, two teams were formed and tied on yellow or red flags for some three-on-three action. Mike Durett, who has been a Rec Aide for the Parks and Recreation Department for about four years and said football is one of his favorite sports, served as coordinator for the game.

TANF Program Specialist II Angelica Crawford squirted paints into plastic holders while Jane Sorroza and JJ Sanders-Alto stayed busy handing out canvases, paintbrushes and other helpful duties. Crawford said Soboba Tribal TANF has offered activities throughout November for Native Heritage Month. This paint workshop preceded ornament beading and leather pouch making classes to close out the month.

“All our classes are open to entire families from all our programs,” Crawford said. “We posted flyers, along with our schedule on social media and made phone calls and texts to make sure everyone knew about them. We had 41 RSVP for this event that is open to all ages.”

Taryn Placencia Grant brought all four of her children because they “love to paint.” Anaya, 8, Liam, 6, Leilani, 4 and Talla, 1, all created colorful pieces that will be going home with them. “We have a whole gallery at home,” Grant said.

Jordyn Placencia, 13, and Laura Celaya, 12, are friends and cousins who heard about the event from their mother and grandmother respectively. “We just wanted to come out and do some art for fun,” they said.

Lopez said the Turkey Bowl was very popular pre-COVID when 30-40 players would come out for the game. It was revived in 2022 and this year he said many of the kids who had enjoyed it in previous years were sidelined with basketball practices at local high schools and other sports team commitments.

“We adopted ITS sports rules with 70 yards total,” Lopez said. “They have four downs to get across the midpoint and another four plays to score a touchdown or the other team gets the ball. We modified it to make it a faster game and a little more fun.”

Red team member Isaac Johnson, 16, from Pala said he was glad to see something offered for the youth. Andrew Salgado, also 16 but from Cahuilla, plays football for Noli Indian School at the Soboba Reservation and said the Braves did pretty well in this year’s season. Pala’s Stephen Isaac, 14, who said his usual sports are baseball and rugby, rounded out the red team.

On the yellow team, Bradly Guachino of Pala is 15 and said he has played rugby for a Valley Center club team for the past seven or so years and likes to play football just for fun. Before the game started, he asked, “How serious are we playing because I’ve got cleats if I need them.” He was joined by teammate Cainen Jaime, 14, also from Pala, who said. “I don’t really play football but it’s cool.” His usual sport is boxing through House of Pain So Cal Boxing & Fitness Club in Temecula. And he regularly participates in activities through the Break Cycle Warriors program, founded by Bradly Guachino Sr. who played on the yellow team to even things out.

Before halftime, Lopez began grilling hot dogs and hamburgers for everyone. When the break came, the score was 30 to 14, in favor of the yellow team.

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On a breezy July morning in South Seattle, a dozen elementary-aged students ran math relays behind an elementary school.

One by one, they raced to a table, where they scribbled answers to multiplication questions before sprinting back to high-five their teammate. These students are part of a summer program run by the nonprofit School Connect WA, designed to help them catch up on math and literacy skills lost during the pandemic. There are 25 students in the program, and all of them are one to three grades behind.

One 11-year-old boy couldn’t do two-digit subtraction. Thanks to the program and his mother, who has helped him each night, he’s caught up. Now, he says math is challenging, but he likes it.

Other kids haven’t fared so well.

Across the country, schools are scrambling to catch up students in math as post-pandemic test scores reveal the depth of missing skills. On average, students’ math knowledge is about half a school year behind where it should be, according to education analysts.

Children lost ground on reading tests, too, but the math declines were particularly striking. Experts say virtual learning complicated math instruction, making it tricky for teachers to guide students over a screen or spot weaknesses in problem-solving skills. Plus, parents were more likely to read with their children at home than practice math.

The result: Students’ math skills plummeted across the board, exacerbating racial and socioeconomic inequities in math performance. And students aren’t bouncing back as quickly as educators hoped, supercharging worries about how they will fare in high school and whether science, tech and medical fields will be available to them.

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The Education Reporting Collaborative, a coalition of eight newsrooms, is documenting the math crisis facing schools and highlighting progress. Members of the Collaborative are AL.com, The Associated Press, The Christian Science Monitor, The Dallas Morning News, The Hechinger Report, Idaho Education News, The Post and Courier in South Carolina, and The Seattle Times.

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Students had been making incremental progress on national math tests since 1990. But over the past year, fourth and eighth grade math scores slipped to the lowest levels in about 20 years, according to data from the National Assessment of Educational Progress, known as the “Nation’s Report Card.”

“It’s a generation’s worth of progress lost,” said Andrew Ho, a professor at Harvard University’s Graduate School of Education.

At Moultrie Middle School in Mount Pleasant, South Carolina, Jennifer Matthews has seen the pandemic fallout in her eighth grade classes. Her students have shown indifference to understanding her pre-algebra and Algebra I lessons.

“They don’t allow themselves to process the material. They don’t allow themselves to think, ‘This might take a day to understand or learn,’” she said.

And recently students have been coming to her classes with gaps in their understanding of math concepts. Basic fractions, for instance, continue to stump many of them, she said.

Using federal pandemic relief money, some schools have added tutors or piloted new curriculum approaches in the name of academic recovery. But that money has a looming expiration date: The September 2024 deadline for allocating funds will arrive before many children have caught up.

Like other districts across the country, Jefferson County Schools in Birmingham, Alabama, saw students’ math skills take a nosedive from 2019 to 2021. Leveraging pandemic aid, the district placed math coaches in all of their middle schools.

The coaches help teachers learn new and better ways to teach students. About 1 in 5 public schools in the United States have a math coach, according to federal data. The efforts appear to be paying off: State testing shows math scores have started to inch back up for most of the Jefferson County middle schools.

In Pittsburgh’s school system, which serves a student population that is 53% African American, special education teacher Ebonie Lamb said it’s “emotionally exhausting” to see the inequities between student groups. But she believes those academic gaps can be closed through culturally relevant lessons, and targeting teaching to each student’s skill level.

Lamb said she typically asks students to do a “walk a mile in my shoes” project in which they design shoes and describe their lives. It’s a way she can learn more about them as individuals. Ultimately, those connections help on the academic front. Last year, she and a co-teacher taught math in a small group format that allowed students to master skills at their own pace.

“All students in the class cannot follow the same, scripted curriculum and be on the same problem all the time,” she said.

Adding to the challenge of catching kids up is debate over how math should be taught. Over the years, experts say, the pendulum has swung between procedural learning, such as teaching kids to memorize how to solve problems step-by-step, and conceptual understanding, in which students grasp underlying math relationships.

“Stereotypically, math is that class that people don’t like. … For so many adults, math was taught just as memorization,” said Kevin Dykema, president of the National Council of Teachers of Mathematics. “When people start to understand what’s going on, in whatever you’re learning but especially in math, you develop a new appreciation for it.”

Teaching math should not be an either-or situation, said Sarah Powell, a professor at the University of Texas at Austin who researches math instruction. A shift too far in the conceptual direction, she said, risks alienating students who haven’t mastered the foundational skills.

“We actually do have to teach, and it is less sexy and it’s not as interesting,” she said.

In Spring, Texas, parent Aggie Gambino has often found herself searching YouTube for math videos. Giada, one of her twin 10-year-old daughters, has dyslexia and also struggles with math, especially word problems. Gambino says helping her daughter has proved challenging, given instructional approaches that differ from the way she was taught.

She wishes her daughter’s school would send home information on how students are being taught.

“The more parents understand how they’re being taught,” she said, “the better participant they can be in their child’s learning.”

Even at a nationally recognized magnet school, the lingering impact of the pandemic on students’ math skills is apparent. At the Townview School of Science and Engineering in Dallas, the incoming ninth graders in Lance Barasch’s summer camp course needed to relearn the meaning of words like “term” and “coefficient.”

“Then you can go back to what you’re really trying to teach,” he said.

Barasch wasn’t surprised that the teens were missing some skills after their chaotic middle school years.

The hope is that by taking a step back, students can begin to move forward.

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A novel treatment using supercharged immune cells appears to work against tumors in children with a rare kind of cancer, researchers reported Wednesday.

Nine of 27 children in the Italian study had no sign of cancer six weeks after the treatment, although two later relapsed and died.

The treatment — called CAR-T cell therapy — is already used to help the immune system fight leukemia and other cancers in the blood. This is the first time researchers have achieved such encouraging results in solid tumors, experts in the field said, and raises hopes that it can be used against other kinds of cancers.

It’s too soon to call it a cure for neuroblastoma, a nerve tissue cancer that often starts in infancy in the adrenal glands near the kidneys in the abdomen.

Standard treatment can be intense, involving chemotherapy, surgery and radiation, depending on the cancer’s stage and other factors. The children in the study had cancers that had come back or were particularly hard to treat.

Eleven children were alive when the three-year study ended, including some who only partially responded to treatment and got repeat doses of the modified cells.

“Those kids were all destined to die without that therapy,” said University of Pennsylvania’s Dr. Carl June, a pioneer of CAR-T therapy who was not involved in the new research.

“No one’s ever had patients responding like this before, so we just don’t know what it’s going to look like a decade from now,” June said. “For sure, there are going to be more trials now based on these exciting results.”

CAR-T cell therapy harnesses the immune system to create “living drugs” able to seek and destroy tumors. T cells from the patient’s blood are collected and strengthened in the lab, then returned to the patient through an IV where they continue to multiply.

Six CAR-T cell therapies have been approved by the U.S. Food and Drug Administration for blood cancers. Some early patients have been cured.

But success in solid tumors has been elusive. The latest study was done by researchers at the Vatican’s Bambino Gesu pediatric hospital in Rome.

“They seem to have found a unique combination” to get the modified cells to multiply initially, then last a long time to continue their cancer-killing work, said Dr. Robbie Majzner of Stanford University School of Medicine, who was not involved in the new study.

Study co-author Dr. Franco Locatelli said they also added a safety switch to eliminate the cells if a patient had a severe reaction. When one patient had problems, they flipped the safety switch, showing that it worked, although later they determined the patient’s problem was caused by a brain bleed unrelated to the CAR-T cells.

Many of the children had a side effect that is common with CAR-T therapy — an immune overreaction called “cytokine release syndrome.” It can be serious, but was mild in most, the researchers reported.

They concluded that CAR-T therapy was “feasible and safe in treating high-risk neuroblastoma.”

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Children struggling with obesity should be evaluated and treated early and aggressively, including with medications for kids as young as 12 and surgery for those as young as 13, according to new guidelines released Monday.

The longstanding practice of “watchful waiting,” or delaying treatment to see whether children and teens outgrow or overcome obesity on their own only worsens the problem that affects more than 14.4 million young people in the U.S. Left untreated, obesity can lead to lifelong health problems, including high blood pressure, diabetes and depression.

“Waiting doesn’t work,” said Dr. Ihuoma Eneli, co-author of the first guidance on childhood obesity in 15 years from the American Academy of Pediatrics. “What we see is a continuation of weight gain and the likelihood that they’ll have (obesity) in adulthood.”

For the first time, the group’s guidance sets ages at which kids and teens should be offered medical treatments such as drugs and surgery — in addition to intensive diet, exercise and other behavior and lifestyle interventions, said Eneli, director of the Center for Healthy Weight and Nutrition at Nationwide Children’s Hospital.

In general, doctors should offer adolescents 12 and older who have obesity access to appropriate drugs and teens 13 and older with severe obesity referrals for weight-loss surgery, though situations may vary.

The guidelines aim to reset the inaccurate view of obesity as “a personal problem, maybe a failure of the person’s diligence,” said Dr. Sandra Hassink, medical director for the AAP Institute for Healthy Childhood weight, and a co-author of the guidelines.

“This is not different than you have asthma and now we have an inhaler for you,” Hassink said.

Young people who have a body mass index that meets or exceeds the 95th percentile for kids of the same age and gender are considered obese. Kids who reach or exceed the 120th percentile are considered to have severe obesity. BMI is a measure of body size based on a calculation of height and weight.

Obesity affects nearly 20% of kids and teens in the U.S. and about 42% of adults, according to the Centers for Disease Control and Prevention.

The group’s guidance takes into consideration that obesity is a biological problem and that the condition is a complex, chronic disease, said Aaron Kelly, co-director of the Center for Pediatric Obesity Medicine at the University of Minnesota.

“Obesity is not a lifestyle problem. It is not a lifestyle disease,” he said. “It predominately emerges from biological factors.”

The guidelines come as new drug treatments for obesity in kids have emerged, including approval late last month of Wegovy, a weekly injection, for use in children ages 12 and older. Different doses of the drug, called semaglutide, are also used under different names to treat diabetes. A recent study published in the New England Journal of Medicine found that Wegovy, made by Novo Nordisk, helped teens reduce their BMI by about 16% on average, better than the results in adults.

Within days of the Dec. 23 authorization, pediatrician Dr. Claudia Fox had prescribed the drug for one of her patients, a 12-year-old girl.

“What it offers patients is the possibility of even having an almost normal body mass index,” said Fox, also a weight management specialist at the University of Minnesota. “It’s like a whole different level of improvement.”

The drug affects how the pathways between the brain and the gut regulate energy, said Dr. Justin Ryder, an obesity researcher at Lurie Children’s Hospital in Chicago.

“It works on how your brain and stomach communicate with one another and helps you feel more full than you would be,” he said.

Still, specific doses of semaglutide and other anti-obesity drugs have been hard to get because of recent shortages caused by manufacturing problems and high demand, spurred in part by celebrities on TikTok and other social media platforms boasting about enhanced weight loss.

In addition, many insurers won’t pay for the medication, which costs about $1,300 a month. “I sent the prescription yesterday,” Fox said. “I’m not holding my breath that insurance will cover it.”

One expert in pediatric obesity cautioned that while kids with obesity must be treated early and intensively, he worries that some doctors may turn too quickly to drugs or surgery.

“It’s not that I’m against the medications,” said Dr. Robert Lustig, a longtime specialist in pediatric endocrinology at the University of California, San Francisco. “I’m against the willy-nilly use of those medications without addressing the cause of the problem.”

Lustig said children must be evaluated individually to understand all of the factors that contribute to obesity. He has long blamed too much sugar for the rise in obesity. He urges a sharp focus on diet, particularly ultraprocessed foods that are high in sugar and low in fiber.

Dr. Stephanie Byrne, a pediatrician at Cedars Sinai Medical Center in Los Angeles, said she’d like more research about the drug’s efficacy in a more diverse group of children and about potential long-term effects before she begins prescribing it regularly.

“I would want to see it be used on a little more consistent basis,” she said. “And I would have to have that patient come in pretty frequently to be monitored.”

At the same time, she welcomed the group’s new emphasis on prompt, intensive treatment for obesity in kids.

“I definitely think this is a realization that diet and exercise is not going to do it for a number of teens who are struggling with this – maybe the majority,” she said.

—- The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

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WASHINGTON (AP) — The COVID-19 pandemic spared no state or region as it caused historic learning setbacks for America’s children, erasing decades of academic progress and widening racial disparities, according to results of a national test that provide the sharpest look yet at the scale of the crisis.

Across the country, math scores saw their largest decreases ever. Reading scores dropped to 1992 levels. Nearly four in 10 eighth graders failed to grasp basic math concepts. Not a single state saw a notable improvement in their average test scores, with some simply treading water at best.

Those are the findings from the National Assessment of Educational Progress — known as the “nation’s report card” — which tested hundreds of thousands of fourth and eighth graders across the country this year. It was the first time the test had been given since 2019, and it’s seen as the first nationally representative study of the pandemic’s impact on learning.

“It is a serious wakeup call for us all,” Peggy Carr, commissioner of the National Center for Education Statistics, a branch of the Education Department, said in an interview. “In NAEP, when we experience a 1- or 2-point decline, we’re talking about it as a significant impact on a student’s achievement. In math, we experienced an 8-point decline — historic for this assessment.”

Researchers usually think of a 10-point gain or drop as equivalent to roughly a year of learning.

It’s no surprise that children are behind. The pandemic upended every facet of life and left millions learning from home for months or more. The results released Monday reveal the depth of those setbacks, and the size of the challenge facing schools as they help students catch up.

Education Secretary Miguel Cardona said it’s a sign that schools need to redouble their efforts, using billions of dollars that Congress gave schools to help students recover.

“Let me be very clear: these results are not acceptable,” Cardona said.

The NAEP test is typically given every two years. It was taken between January and March by a sample of students in every state, along with 26 of the nation’s largest school districts. Scores had been stalling even before the pandemic, but the new results show decreases on a scale not seen before.

In both math and reading, students scored lower than those tested in 2019. But while reading scores dipped, math scores plummeted by the largest margins in the history of the NAEP test, which began in 1969.

Math scores were worst among eighth graders, with 38% earning scores deemed “below basic” — a cutoff that measures, for example, whether students can find the third angle of a triangle if they’re given the other two. That’s worse than 2019, when 31% of eighth graders scored below that level.

No part of the country was exempt. Every region saw test scores slide, and every state saw declines in at least one subject.

Several major districts saw test scores fall by more than 10 points. Cleveland saw the largest single drop, falling 16 points in fourth-grade reading, along with a 15-point decline in fourth-grade math. Baltimore and Tennessee’s Shelby County also saw precipitous declines.

“This is more confirmation that the pandemic hit us really hard,” said Eric Gordon, chief executive for the Cleveland Metropolitan School District. To help students recover, the school system has beefed up summer school and added after-school tutoring.

“I’m not concerned that they can’t or won’t recover,” Gordon said. “I’m concerned that the country won’t stay focused on getting kids caught up.”

The results show a reversal of progress on math scores, which had made big gains since the 1990s. Reading, by contrast, had changed little in recent decades, so even this year’s relatively small decreases put the averages back to where they were in 1992.

Most concerning, however, are the gaps between students.

Confirming what many had feared, racial inequities appear to have widened during the pandemic. In fourth grade, Black and Hispanic students saw bigger decreases than white students, widening gaps that have persisted for decades.

Inequities were also reflected in a growing gap between higher and lower performing students. In math and reading, scores fell most sharply among the lowest performing students, creating a widening chasm between struggling students and the rest of their peers.

Surveys done as part of this year’s test illustrate the divide.

When schools shifted to remote learning, higher performing students were far more likely to have reliable access to quiet spaces, computers and help from their teachers, the survey found.

The results make clear that schools must address the “long-standing and systemic shortcomings of our education system,” said Alberto Carvalho, superintendent of Los Angeles schools and a member of the National Assessment Governing Board, which sets the policies for the test.

“While the pandemic was a blow to schools and communities, we cannot use it as an excuse,” he said. “We have to stay committed to high standards and expectations and help every child succeed.”

Other recent studies have found that students who spent longer periods learning online suffered greater setbacks. But the NAEP results show no clear connection. Areas that returned to the classroom quickly still saw significant declines, and cities — which were more likely to stay remote longer — actually saw milder decreases than suburban districts, according to the results.

Los Angeles can claim one of the few bright spots in the results. The nation’s second-largest school district saw eighth-grade reading scores increase by 9 points, the only significant uptick in any district. For other districts, it was a feat just to hold even, as achieved by Dallas and Florida’s Hillsborough County.

Testing critics caution against putting too much stock in exams like NAEP, but there’s no doubt that the skills it aims to measure are critical. Students who take longer to master reading are more likely to drop out and end up in the criminal justice system, research has found. And eighth grade is seen as a pivotal time to develop skills for math, science and technology careers.

For Carr, the results raise new questions about what will happen to students who appear to be far behind in attaining those skills.

“We want our students to be prepared globally for STEM careers, science and technology and engineering,” she said. “This puts all of that at risk. We have to do a reset. This is a very serious issue, and it’s not going to go away on its own.”

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AP education writer Bianca Vázquez Toness in Boston contributed to this report.

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The U.S. on Wednesday authorized updated COVID-19 boosters for children as young as 5, seeking to expand protection ahead of an expected winter wave.

Tweaked boosters rolled out for Americans 12 and older last month, doses modified to target today’s most common and contagious omicron relative. While there wasn’t a big rush, federal health officials are urging that people seek the extra protection ahead of holiday gatherings.

Now the Food and Drug Administration has given a green light for elementary school-age kids to get the updated booster doses, too — one made by Pfizer for 5- to 11-year-olds, and a version from rival Moderna for those as young as 6.

The Centers for Disease Control and Prevention, which recommends how vaccines are used, also signed off.

Americans may be tired of repeated calls to get boosted against COVID-19 but experts say the updated shots have an advantage: They contain half the recipe that targeted the original coronavirus strain and half protection against the dominant BA.4 and BA.5 omicron versions.

These combination or “bivalent” boosters are designed to broaden immune defenses so that people are better protected against serious illness whether they encounter an omicron relative in the coming months — or a different mutant that’s more like the original virus.

“We want to have the best of both worlds,” Pfizer’s Dr. Bill Gruber, a pediatrician, told The Associated Press. He hopes the updated shots will “re-energize interest in protecting children for the winter.”

The updated boosters are “extremely important” for keeping kids healthy and in school, said Dr. Jason Newland, a pediatric infectious disease specialist at Washington University in St. Louis.

Parents should know “there is no concern from the safety perspective with the bivalent vaccines, whether Moderna or Pfizer,” Newland added.

Only people who’ve gotten their initial vaccinations — with any of the original-formula versions — qualify for an updated booster. That means about three-fourths of Americans 12 and older are eligible. As of last weekend, only at least 13 million had gotten an updated booster, White House COVID-19 coordinator Dr. Ashish Jha estimated Tuesday.

To pediatricians’ chagrin, getting children their first vaccinations has been tougher. Less than a third of 5- to 11-year-olds have had their two primary doses and thus would qualify for the new booster.

This age group will get kid-size doses of the new omicron-targeting booster — and they can receive it at least two months after their last dose, whether that was their primary vaccination series or an earlier booster, the FDA said.

“Vaccination remains the most effective measure to prevent the severe consequences of COVID-19,” Dr. Peter Marks, FDA’s vaccine chief, said in a statement.

While children tend to get less seriously ill than adults, “as the various waves of COVID-19 have occurred, more children have gotten sick with the disease and have been hospitalized,” Marks said.

For the updated booster made by Pfizer and its partner BioNTech, 5- to 11-year-olds would get a third of the dose that anyone 12 and older already receives. Pfizer said it could ship up to 6 million kid-sized doses within a week of authorization, in addition to ongoing shipments of adult-sized doses.

Until now, Moderna’s updated booster was cleared only for adults. FDA just expanded that adult bivalent dosage to 12- to 17-year-olds, and authorized half the dose for kids ages 6 to 11.

As for even younger tots, first vaccinations didn’t open for the under-5 age group until mid-June — and it will be several more months before regulators decide if they’ll also need a booster using the updated recipe.

Exactly how much protection does an updated COVID-19 booster shot offer? That’s hard to know. Pfizer and Moderna are starting studies in young children.

But the FDA cleared the COVID-19 booster tweaks without requiring human test results — just like it approves yearly changes to flu vaccines. That’s partly because both companies already had studied experimental shots tweaked to target prior COVID-19 variants, including an earlier omicron version, and found they safely revved up virus-fighting antibodies.

“It’s clearly a better vaccine, an important upgrade from what we had before,” Jha said earlier this week.

Jha urged adults to get their updated shot in October — like they get flu vaccinations — or at least well before holiday gatherings with high-risk family and friends. People who’ve recently had COVID-19 still need the booster but can wait about three months, he added.

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.

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CHICAGO (AP) — As the new school year swings into gear, some students carry heavier worries than keeping up with homework: Demand has been growing steadily for children’s books that address traumatic events such as school shootings.

Sales of books for young readers on violence, grief, and emotions have increased for nine straight years, with nearly six million copies sold in 2021 — more than double the amount in 2012, according to NPD BookScan, which tracks U.S. retail sales of print books.

As anxiety and depression rates have soared among young Americans, educators and advocates say children’s books can play a role in helping them cope.

“While it might be second nature to try to shield kids from the harsher realities of life and scary news, it’s proving difficult to avoid big society issues,” said Kristine Enderle, editorial director at Magination Press, the children’s publishing arm of the American Psychology Association. “Kids face these issues and challenges in their day-to-day life.”

One book, “I’m Not Scared … I’m Prepared,” was reprinted several times to meet demand after the massacre at Uvalde’s Robb Elementary School in May, according to the National Center for Youth Issues, the nonprofit group that published the book. The story, first published in 2014, features a teacher who shows children what to do when a “dangerous someone” is in their school.

Bookstores around the country see interest in titles from the genre rise and fall depending on local and national headlines, according to bookseller Barnes & Noble.

Some newer titles engage directly with real-world gun violence.

In “Numb to This,” a graphic novel released this month, author Kindra Neely details the 2015 Umpqua Community College shooting in Oregon, which she survived, and the aftermath as she tries to heal amid repeated shootings elsewhere. Initially, Little, Brown Books for Young Readers editorial director Andrea Colvin said she was shocked when Keely pitched the idea.

“I had to remember that, yes, this is what our stories are like now. This is what young people have experienced,” Colvin said.

Michele Gay, whose 7-year-old daughter Josephine was killed in the 2012 Sandy Hook Elementary School shooting, turned to children’s books herself to help her two surviving daughters. One picture book she read to them was “The Ant Hill Disaster,” about a boy ant who is afraid to go back to school after it is destroyed.

“It was one of many books that was of comfort to them and gave them a little bit of confidence to just face one more day, one more minute, because we can do it together,” said Gay, who advocates for improved security in schools through a nonprofit she co-founded, Safe and Sound Schools.

Parents should make sure books addressing trauma are age-appropriate and backed by psychologists, experts say.

It’s important to be aware of whether children are aware of or feeling stress about frightening things in the news, said Aryeh Sova, a Chicago psychologist who works with children who attended the July 4 parade in suburban Highland Park, Illinois, where seven people were killed in a shooting. A child asking lots of questions about an event may signify that they are anxious or fixated on it, he said.

“If it’s coming from the kid’s need, then books could be a great way for kids to learn and to read together with their parents and to review it on their own and to process it at their own speed, at their own pace,” Sova said.

But bringing up violence when a child isn’t worried about it could increase their anxiety unnecessarily, Sova said.

Some young children experience gun violence at alarmingly high rates, particularly in communities of color.

For them, it is important to start early to address the effects, said Ian Ellis James, an Emmy award-winning Sesame Street writer known by his stage name William Electric Black. He is the author of the illustrated children’s book “ A Gun Is Not Fun.” He said young children in areas afflicted by gun violence are more aware of it than parents may think.

“They know about flowers and candles and cards in the street. They walk by them every day,” he said.

Through children’s literature and theater, Black works to reduce urban gun violence. “If you start when they’re 5, and you go back when you’re 6, 7, 8, 9, you’re going to change the behavior,” he said.

In the spring, he will collaborate with New York public school P.S. 155 in East Harlem with a series of gun violence awareness and prevention workshops for early readers, using puppets, storytelling and repetition.

“They won’t even get rid of assault weapons here in this country. So my thing is, we have to go in and we’ve got to help them help themselves save themselves,” Black said. “We’re really kind of failing at that.”

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The first COVID-19 shots for U.S. infants, toddlers and preschoolers moved a step closer Wednesday.

The Food and Drug Administration’s vaccine advisers gave a thumbs-up to vaccines from Moderna and Pfizer for the littlest kids.

The outside experts voted unanimously that the benefits of the shots outweigh any risks for children under 5 — that’s roughly 18 million youngsters. They are the last age group in the U.S. without access to COVID-19 vaccines and many parents have been anxious to protect their little children.

If all the regulatory steps are cleared, shots should be available next week.

“This is a long-awaited vaccine,” said one panel member, Dr. Jay Portnoy of Children’s Hospital in Kansas City, Missouri. “There are so many parents who are absolutely desperate to get this vaccine and I think we owe it to them to give them a choice to have the vaccine if they want to.”

Dr. Peter Marks, FDA’s vaccine chief, opened the meeting with data showing a “quite troubling surge” in young children’s hospitalizations during the omicron wave, and noted 442 children under 4 have died during the pandemic. That’s far fewer than adult deaths, but should not be dismissed in considering the need for vaccinating the youngest kids, he said.

“Each child that’s lost essentially fractures a family,” Marks said.

While endorsing the vaccines, some panel members said they believe chances are minimal for severe illness and death in young children.

“Risks from vaccination are very low, but so are risks from COVID-19 for the youngest kids,” said Dr. Cody Meissner of Tufts University.

FDA reviewers said both brands appear to be safe and effective for children as young as 6 months old in analyses posted ahead of the all-day meeting. Side effects, including fever and fatigue, were generally minor in both, and less common than seen in adults.

The two vaccines use the same technology but there are differences. In a call with reporters earlier this week, vaccine experts noted that the shots haven’t been tested against each other, so there’s no way to tell parents if one is superior.

“You can’t compare the vaccines directly,” said Dr. Jesse Goodman of Georgetown University, a former FDA vaccine chief.

If the FDA agrees with its advisers and authorizes the shots, there’s one more step. The Centers for Disease Control and Prevention will decide on a formal recommendation after its own advisers vote on Saturday. If the CDC signs off, shots could be available as soon as Monday or Tuesday at doctor’s offices, hospitals and pharmacies.

Pfizer’s vaccine is for children 6 months through 4 years; Moderna’s vaccine is for 6 months through 5 years.

Moderna’s shots are one-quarter the dose of the company’s adult shots. Two doses appeared strong enough to prevent severe illness but only about 40% to 50% effective at preventing milder infections. Moderna added a booster to its tests and expects to eventually offer one.

Pfizer’s shots are just one-tenth its adult dose. Pfizer and partner BioNTech found that two shots didn’t provide enough protection in testing, so a third was added during the omicron wave.

Pfizer’s submitted data found no safety concerns and suggested that three shots were 80% effective in preventing symptomatic coronavirus infections. But that was based on just 10 COVID-19 cases; the calculation could change as more cases occur in the company’s ongoing studies.

Several advisers, noting that protection is low after two Pfizer doses, worried that some parents might end up skipping the third shot, or mistakenly thinking their kids are better protected between shots, leaving them vulnerable.

Educating parents must be done “very very carefully so that they are not misled about what the vaccines actually provide,” said Dr. Archana Chatterjee of Rosalind Franklin University.

The same FDA panel on Tuesday backed Moderna’s half-sized shots for ages 6 to 11 and full-sized doses for teens. If authorized by the FDA, it would be the second option for those age groups. Currently Pfizer vaccine is their only choice.

The nation’s vaccination campaign started in December 2020 with the rollout of adult vaccines from Pfizer and Moderna, with health care workers and nursing home residents first in line. Teens and school-age children were added last year.

Moderna said in April that it is also seeking regulatory approval outside the U.S. for its little kid shots. According to the World Health Organization, 12 countries already vaccinate kids under 5, with other brands.

In the U.S., it remains uncertain how many parents want their youngest vaccinated. By some estimates, three-quarters of all children have already been infected. And only about 29% of children aged 5 to 11 have been vaccinated since Pfizer’s shots opened to them last November, a rate far lower than public health authorities consider ideal.

Dr. Nimmi Rajagopal, a family medicine physician at Cook County Health in Chicago, said she’s been preparing parents for months.

“We have some that are hesitant, and some that are just raring to go,” she said.

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WASHINGTON (AP) — Federal health officials said Sunday that kid-sized doses of Pfizer’s COVID-19 vaccines appear to be safe and effective for kids under 5, a key step toward a long-awaited decision to begin vaccinating the youngest American children.

The Food and Drug Administration posted its analysis of the Pfizer shot ahead of a Wednesday meeting where outside experts will vote on whether the shots are ready for the nation’s 18 million babies, toddlers and preschoolers. Kids under 5 are the only group not yet eligible for COVID-19 vaccination in the U.S.

Late last week the FDA posted a similar analysis of Moderna’s shots for children under 6.

If regulators clear the shots by one or both companies, vaccinations could begin as soon as next week with the drugmakers ready to rapidly ship doses ordered by the government. Parents have been pressing federal officials for months for the opportunity to protect their smallest children as more adults shed masks and abandon other public health precautions.

While only about 3% of U.S. COVID cases are in the age group 6 months to 4 years, hospitalization and death rates in that group are higher than those for older children, according to the FDA’s analysis — one reason experts have said protecting this group is important.

The FDA said children who received Pfizer’s shots during testing developed high levels of virus-fighting antibodies expected to protect them against coronavirus. That’s the basic threshold needed to win FDA authorization. But additional testing turned up key differences, with stronger results for Pfizer.

Pfizer’s vaccine, given as a three-shot series, appeared 80% effective in preventing symptomatic COVID-19, although that calculation was based on just 10 cases diagnosed among study participants. The figure could change as Pfizer’s study continues.

Moderna’s two-dose series was only about 40% to 50% effective at preventing milder infections, though the two companies’ shots were tested at different times during the pandemic, when different variants were circulating. Moderna has begun testing a booster for tots.

On Wednesday, the FDA will ask an independent panel of vaccine experts to debate both companies’ data before voting. The FDA is not required to follow the group’s recommendations, but the process is seen as a key step in publicly vetting the shots.

The FDA is expected to make its official decision shortly after Wednesday’s all-day meeting. The next step: the Centers for Disease Control and Prevention, which recommends how to use vaccines, will convene its own expert panel to debate which tots need vaccinations.

It’s not clear how much demand there will initially be for the shots. A recent survey suggests only 1 in 5 parents of young children would get their kids vaccinated right away. Vaccines have been available since November for older U.S. schoolchildren, yet less than a third of those ages 5 to 11 have gotten the two recommended doses, according to government figures.

For the youngest children, each company is offering different dose sizes and number of shots, beginning at 6 months through 4 years for Pfizer and through 5 years for Moderna.

Pfizer and its partner BioNTech plan to offer two shots three weeks apart followed by a third at least two months later — each one-tenth the dose given to adults. Pfizer is currently the only company with a COVID-19 vaccine for older U.S. children.

Moderna is seeking FDA clearance for two shots, each a quarter of its adult dose, given about four weeks apart.

The FDA currently allows Moderna’s vaccine to be used only in adults. But some countries allow full-size doses for teens and half-size shots for kids ages 6 to 11 — a step the FDA also is considering.

More than 30,000 U.S. children younger than 5 have been hospitalized with COVID-19 and nearly 500 coronavirus deaths have been reported in that age group, according to U.S. health officials.

The government allowed pharmacies and states to start placing orders for tot-sized doses last week, with 5 million initially available — half made by Pfizer and half by Moderna.

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WASHINGTON (AP) — The Biden administration said Thursday that children under 5 may be able to get their first COVID-19 vaccination doses as soon as June 21, if federal regulators authorize shots for the age group, as expected.

White House COVID-19 coordinator Ashish Jha outlined the administration’s planning for the last remaining ineligible age group to get shots. He said the Food and Drug Administration’s outside panel of advisers will meet on June 14-15 to evaluate the Pfizer and Moderna shots for younger kids. Shipments to doctors’ offices and pediatric care facilities would begin soon after FDA authorization, with the first shots possible the following week.

Jha said states can begin placing orders for pediatric vaccines on Friday, and said the administration has an initial supply of 10 million doses available. He said it may take a few days for the vaccines to arrive across the country and vaccine appointments to be widespread.

“Our expectation is that within weeks every parent who wants their child to get vaccinated will be able to get an appointment,” Jha said.

The timeline would provide parents with the opportunity to get their children fully vaccinated in time for the beginning of the next school year.

The Biden administration is pressing states to prioritize large-volume sites like children’s hospitals, and to make appointments available outside regular work hours to make it easier for parents to get their kids vaccinated.

In the view of the White House, eliminating the last significant cohort not yet eligible for vaccines will go a long way in building confidence among some Americans who have been wary to return to many of their pre-pandemic activities, helping the country emerge from the pandemic.

Jha acknowledged the “frustration” of parents of young children who have been waiting more than a year for shots for their kids.

“At the end of the day we all want to move fast, but we’ve got to get it right,” he said.

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