Pediatricians Offer “Top 10 List” of Tests or Treatments That Parents, Physicians Should Question

The American Academy of Pediatrics and Choosing Wisely has released a new top 10 list of tests and treatments in pediatric medicine that should be questioned. Image: iStock.com/herjua

The American Academy of Pediatrics and Choosing Wisely has released a new top 10 list of tests and treatments in pediatric medicine that should be questioned. Image: iStock.com/herjua

In an effort to reduce the unnecessary use of medical interventions for children, a pediatrics group has released an updated list of common diagnostic tests and treatments that physicians and parents should question.

This week, adding to a “top 5 list” that was released in February 2013, the American Academy of Pediatrics (AAP) released a second list of 5 things commonly done in the field of pediatrics that should be questioned by doctors, patients, and parents. This effort is part of the Choosing Wisely campaign, a nationwide initiative developed by the American Board of Internal Medicine (ABIM) Foundation that encourages doctors and patients to do just that when faced with the myriad tests, procedures, and treatments that are so readily available in this current era of medicine.

Since 2011, Choosing Wisely has published top 5 lists of common practices that both physicians and patients should question in terms of their true medical necessity for more than 40 subspecialties of medicine. The lists were developed by various subspecialty professional societies through extensive reviews of current scientific research that allowed careful weighing of the costs, risks, and benefits of each intervention. The AAP’s list is one of the first top 10 lists to be published.

The new recommendations on the expanded list for pediatric medicine include:

  • Do not give high-dose steroids (in place of lower-dose steroids) for the prevention or treatment of lung problems (bronchopulmonary dysplasia) in premature infants
  • Do not perform screening panels for food allergies without previous consideration of medical history
  • Avoid using acid blockers and motility agents for gastroesophageal reflux that is painless, “effortless” (not associated with anything except stained clothes), and not affecting growth; do not use medication in the so-called “happy-spitter”
  • Avoid the use of surveillance cultures for the screening and treatment of bacteria in the urine when it is asymptomatic
  • Do not routinely use infant home apnea monitors to prevent sudden infant death syndrome (SIDS)

These new items join the AAP’s previous Choosing Wisely recommendations that address the use of antibiotics for viral respiratory infections, the use of cough and cold medications in younger children, and the use of imaging to evaluate minor head injuries, fever-related seizures, or abdominal pain.

The Choosing Wisely lists are intended to stimulate conversation between physicians and patients (or parents), and should not be viewed as a rigid set of guidelines or rules. The campaign’s history is discussed in a previous news@JAMA post about the release of the top 5 list for pulmonary medicine in November 2013.



Categories: Pediatrics, Quality of Care