The American Academy of Pediatrics (AAP) has released a list of specific tests or treatments that are commonly given to children, but are not always necessary, as part of the Choosing Wisely® campaign, an initiative of the ABIM Foundation. The Choosing Wisely campaign helps to raise awareness of the need to evaluate tests and treatments thoughtfully.
Pediatricians want the best possible tests and treatments for their patients, and they want them to be used appropriately.
The AAP list below identifies five targeted, evidence-based recommendations that can support and encourage conversations between parents and doctors about what care is really necessary.
Five Tests or Treatments to Discuss with Your Child’s Doctor:
- Antibiotics should not be used for viral respiratory illnesses (sinusitis, pharyngitis, bronchitis).
Cough and cold medicines should not be prescribed or recommended for respiratory illnesses in children under four years of age.
- Although overall antibiotic prescription rates for children have fallen, they still remain alarmingly high. Unnecessary medication use for viral respiratory illnesses can lead to antibiotic resistance and contributes to higher health care costs and the risks of adverse events.
Computed tomography (CT) scans are not necessary in the immediate evaluation of minor head injuries; clinical observation/Pediatric Emergency Care Applied Research Network (PECARN) criteria should be used to determine whether imaging is needed.
- Research has shown these products offer little benefit to young children and can have potentially serious side effects. Many cough and cold products for children have more than one ingredient, increasing the chance of accidental overdose if combined with another product.
Neuroimaging (CT, MRI) is not necessary in a child with a simple febrile seizure.
- Minor head injuries occur commonly in children and adolescents. Approximately 50% of children who visit hospital emergency departments with a head injury are given a CT scan, many of which may be unnecessary. Unnecessary exposure to x-rays poses considerable danger to children including increasing the lifetime risk of cancer because a child’s brain tissue is more sensitive to ionizing radiation. Unnecessary CT scans impose undue costs to the health care system. Clinical observation prior to CT decision-making for children with minor head injuries is an effective approach.
Computed tomography (CT) scans are not necessary in the routine evaluation of abdominal pain.
- CT scanning is associated with radiation exposure that may escalate future cancer risk. MRI also is associated with risks from required sedation and high cost. The literature does not support the use of skull films in the evaluation of a child with a febrile seizure. Clinicians evaluating infants or young children after a simple febrile seizure should direct their attention toward identifying the cause of the child’s fever.
- Utilization of CT imaging in the emergency department evaluation of children with abdominal pain is increasing. The increased lifetime risk for cancer due to excess radiation exposure is of special concern given the acute sensitivity of children’s organs. There also is the potential for radiation overdose with inappropriate CT use.