Choosing Wisely: Medical Recommendations for Children

Jennifer Yttri, PhD
August 2013

 

Parents are the ones that must make medical decisions for their children, from birth until adulthood. While many parents will do everything they can to make sure their children stay healthy or get well, too many tests or treatments can do more harm than good, and many are over-used. Sometimes the best way to help your child is not through medication or tests. Instead of asking for a test, procedure, or medication, discuss the risks and benefits to your child with a doctor. What is appropriate for one child isn’t worth the risks for another.

The best health decisions can be made when physicians take the time to talk with their patients and patients ask questions rather than just assuming the doctor always knows best.

Consumer Reports and the ABIM Foundation are working with medical specialty societies to create lists of “5 Things Physicians and Patients Should Question” as part of a national campaign called Choosing Wisely (www.choosingwisely.org). These medical groups represent more than 500,000 physicians. The lists are recommendations made by experts based on scientific evidence. Here is the list of their recommendations on medical treatment and testing for children.

 

Allergy Tests

Skin or blood tests for allergies should only be used if a patient has allergic symptoms that are not controlled by over-the-counter medications or if a doctor suspects an allergy. Allergy tests are costly and can detect allergic responses that may never happen in real life. Allergy tests should not be used to figure out why someone has chronic hives, as those do not normally result from allergies.

Asthma

Asthma should not be treated or diagnosed without measuring lung function. Lung function can be tested with spirometry. This simple breathing test is much better at diagnosing asthma than having a patient provide a history of symptoms or doing a physical exam. Diagnosis without spirometry can lead to prescribing asthma medication to people who don’t have asthma. Spirometry testing should be done a few months after starting treatment and at least once every two years.

Bronchiolitis and Respiratory Infections in Children

Respiratory tract infections are common in children. Corticosteroids and bronchodilators are not recommended for treating lower respiratory tract infections or bronchiolitis in children, because they are not proven effective and have risks that can be harmful. Chest x-rays, used to diagnose some respiratory infections like TB, are not recommended for diagnosing bronchiolitis or common childhood respiratory infections.  Physical exams and patient history are much more reliable ways to diagnose these. Chest x-rays should not be used to diagnose a child with asthma-like symptoms (see asthma above).

Children with Febrile Seizures

Febrile seizures happen when children have a high fever. Doctors should try to identify the cause of the fever when treating infants or children who have had a febrile seizure. CT and MRI scans of the brain are not recommended for children who have had a febrile seizure. CT scans use radiation and exposing children to radiation can increase their risk of developing cancer. MRI scans are very costly and require sedation, which exposes children to unnecessary risks.

Children with Febrile Urinary Tract Infections

Children aged 2-24 months with a first-time febrile urinary tract infection (UTI accompanied by fever) should not get a voiding cystourethrogram, which is an x-ray of the bladder and urethra. It is better to delay this test since the risks from radiation, as well as the discomfort and procedure costs, are greater than the risks of delaying.

Cough and Cold Medications for Children

Cough and cold medicines can have serious side effects and often contain more than one active ingredient. Research studies have concluded that these medications offer little benefit to children and can have risks of accidental overdose. Therefore they are not recommended for children under age 4.

CT Scans in Children

Computed tomography or CT scans use radiation for imaging. Exposing children to radiation is especially risky for increasing their lifetime risk of cancer because their tissues are sensitive to radiation. CT test are not recommended for children who are being treated for minor head injuries, febrile seizure, or abdominal pain including appendicitis.

Ear Infections in Middle Ear

Children aged 2-12 years with otitis media (a middle ear infection) should not take antibiotics if they do not have severe symptoms. Consult a doctor about ways to ease non-severe symptoms and whether it is best to wait for 3-4 days to see if the infection clears up by itself before prescribing antibiotics. Monitor your child’s condition closely for any developments or changes and communicate with your doctor. 

Scoliosis Screening in Adolescents

Adolescents who do not have any symptoms should not be screened for scoliosis. According to the U.S. Preventive Services Task Force, “Most cases detected through screening will not progress to a clinically significant form of scoliosis.” Cases of scoliosis that do require treatment are usually identified without screening. The negative consequences of screening may include unnecessary follow-up visits, false-positive test results, and harmful psychological effects. Adolescents should only be screened for scoliosis if the doctor notices a problem or the adolescent or parent expresses concern about it.