Healthy, Happy Kids: Choosing Wisely

Some parents have recently asked me about the treatments and tests they request when their child presents with a medical problem their physician is not able to solve with the child’s health history and a basic exam.

Well, let me see if I can examine their concerns and provide some information to help parents and doctors choose more wisely when taking care of children.

The American Academy of Pediatrics has released a set of common tests or treatments that are offered but not necessarily indicated for children. This is part of a national campaign called Choosing Wisely—an initiative of the American Board of Internal Medicine. I encourage you as parents to discuss five evidence-based recommendations with your child’s doctors and nurses if they don’t discuss them with you first. 

  1. First, antibiotics should not be used for viral respiratory infections such as colds, sinusitis and even a sore throat unless a throat culture grows the strep germ. Otherwise we are setting up for antibiotic resistance, which can be a real problem when a child gets a serious infection.
  2. Cough and cold medicines should not be used for respiratory illnesses in children under four years of age since they have been found to have serious side effects and no health benefits.
  3. CT scans are not necessary for minor head injuries. Observation in a clinical setting can be used to determine if a scan is needed—especially given what we now know about how unnecessary exposure to x-rays can increase a child’s risk of getting cancer.
  4. Skull x-rays, CT scans and MRIs are not recommended for children who have a febrile seizure that lasts less than five minutes and is associated with a fever. This will spare them from unnecessary radiation risk or the use of sedating drugs. These seizures are not dangerous and rarely lead to recurrence or long-term epilepsy.
  5. Finally, CT scans should not be used in the routine evaluation of abdominal pain. If there is nothing else worrisome on an examination, there is no need to expose children to more radiation – especially when there is a low yield on making diagnoses this way.

It is important to note that ordering fewer tests does not mean your child’s doctor is less concerned. In fact, it may result in even closer follow-up of your child so that should symptoms change, reevaluation of your child will follow sooner than later. Hopefully these suggestions will allow you and your child’s doctor to choose tests and treatments that consider the risks as well as the benefits.

Lewis First, M.D., is chief of Pediatrics at Vermont Children's Hospital at Fletcher Allen Health Care and chair of the Department of Pediatrics at the University of Vermont College of Medicine. You can also catch "First with Kids" weekly on WOKO 98.9FM and WPTZ Channel 5, or visit the First with Kids video archives at www.FletcherAllen.org/firstwithkids.