New recommendations by American Academy of Pediatrics merit parent–doctor discussions

	(L-R) Angela L. Beeler, MD, and Lynda Young, MD
	American Academy of Pediatrics Recommendations for Preventive Pediatric Health Care updated schedule: Risk-based vision assessment at age 18 (no longer routine screening); Add fluoride varnish applications from 6 months through 5 years; Use CRAFFT screening questionnaire as a tool to screen adolescents for drug and alcohol use; Universal depression annual screening in ages 11 through 21 years; Universal dyslipidemia screening for patients 9 through 11 years old; Risk assessment for hematocrit or hemoglobin screening to detect anemia at 15 and 30 months; Universal HIV screening for adolescents 16 to 18 years old; Screen for cervical dysplasia at age 21-years only; and, Screen for critical congenital heart disease using pulse oximetry before newborn is discharged from hospital.

Child well visits should include universal HIV tests for youth between 16 and 18 and cholesterol screenings for children 9 to 11, according to new recommendations from the American Academy of Pediatrics. UMass Medical School pediatric experts say the screenings merit discussion between parents, patients and doctors.

The HIV testing recommendation, to be issued in January, is in response to federal statistics that show one in four new HIV infections occur in individuals between 13 and 24 years old. In addition, about 60 percent of all youth with HIV do not know they are infected, according to the academy.

Lynda Young, MD, clinical professor of pediatrics, and Angela L. Beeler, MD, clinical associate professor of pediatrics, said the decision whether to order a blood test should be based on communication and history between a patient and his or her doctor. 

“Would I do universal HIV screening in all of my 16-year-olds? Probably not, but I will do it more often with the people who are sexually active,” Dr. Beeler said.

Dr. Young said the recommendation for universal screening is a good thing and that a lot of her patients who are sexually active have requested an HIV test; however, she is not sure how most pediatricians will react to the new recommendation. She added that it might not be necessary to test teens who are not sexually active or otherwise not at risk for infection. Communication between patient and physician, and possibly parent, is the key to that decision, the pediatricians said.

A similar stance could be taken on the academy’s new recommendation that screening for dyslipidemia, or high blood cholesterol levels, should be administered to patients between 9 and 11 years old. The academy made the change in response to increased concerns about the growing epidemic of obesity in children.

Beeler and Young said there are currently no studies to show that medical intervention in a child with high cholesterol will reduce that child’s risk as an adult. However, they said identifying a child with a high lipid level could act as a good conversation starter with parents.

Young said that she is not aware of children as young as 9 being treated with a statin, even if it’s related to a familial risk, but the presumption is the screening could encourage adults to change their child’s dietary habits.

“They’re seeing so many adults with dyslipidemia that the hope is if you intervene in kids you can get things normalized again . . . if you have children with elevated lipid levels you can get them to do the exercise, the weight loss,” Beeler said.

Although cholesterol screening for children is not routinely administered, it could be issued on a case-by-case basis when the parents have a high LDL count or the child is obese.

The physician–patient relationship can also provide a greater perspective into a patient’s behavioral health, particularly in regard to depression. With suicide now the leading cause of death among adolescents, the AAP has added annual depression screening for children starting at 11 years old to its universal screening and assessments recommendations.

Beeler said Massachusetts is ahead of the curve when it comes to screening for developmental and behavioral health issues. Most pediatricians use an extensive emotional and physical health questionnaire for children as young as 6. Based on answers given, a pediatrician can use it as a conversation starter to determine whether future evaluation is needed.