Choosing Wisely: First With Kids - Vermont Children's Hospital, Fletcher Allen

Choose Wisely When Testing and Treating Children

Some parents have recently asked me if it’s okay to ask for additional tests or medications like antibiotics even when their child’s health care provider is not sure what’s causing their child to feel ill.  

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

The American Academy of Pediatrics has released a set of five recommendations regarding common tests or treatments that are readily available but may not be indicated when a child doesn’t feel well. This is part of a national campaign called “Choosing Wisely.” I encourage you as parents to discuss these 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 and runny noses – or even a sore throat, unless a throat culture grows the strep germ. Otherwise we are setting our children and ourselves up for antibiotic resistance, which can be a real problem when a child gets a serious infection and the antibiotics we have available to us will no longer work.

2.    Cough and cold medicines should not be used for respiratory illnesses in children under four years of age. These medicines have been found to have serious side effects and essentially no health benefits when it comes to getting rid of the germ causing the respiratory infection.

3.    CT scans are not necessary for minor head injuries. Clinical observation criteria can be used to determine if a scan is needed, especially given what we now know about how unnecessary exposure to x-rays such as those received from a CT scan – especially multiple scans – 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 simple seizure in association with a fever. This will again spare them from unnecessary radiation risk or the use of sedating drugs. These febrile seizures are not dangerous and rarely lead to recurrence, long-term epilepsy or other neurologic problems.

5.    Finally, CT scans should not be used in the routine evaluation of abdominal pain. If the pain cannot be specifically localized on physical examination and your child’s health care provider is not worried by the history of the pain such that he or she needs to look at a particular area of the abdomen through a CT scan, then there is no need to expose children to more radiation – especially when there is a low yield to making diagnoses this way.

It is important to note that ordering fewer tests or not using antibiotics 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 help you and your child’s health care provider to choose tests and treatments more wisely and not allow their risks outweigh their 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.