the am acad of pediatrics just came out with new pediatric preventive care guidelines (see http://pediatrics.aappublications.org/content/early/2014/02/18/peds.2013-4096.full.pdf). the guidelines are basically a chart of either things to do on all kids, or targeted assessments — risk assessment with appropriate action to follow if positive. the basic changes are:
development/behavior:
–depression screen yearly from ages 11 through 21, esp using PHQ-2
–alcohol and drug screen yearly from ages 11 through 21, esp using CRAFFT (this is to do targeted assessment, with appropriate action if positive)
procedures:
–lipid screening: targeted at age 24 mo, 2 y, 4 y, 6 y, 8 y, then once for all kids aged 9-11 y (this is the new recommendation), then targeted annually from 12-17 y, then again once for all kids aged 18-21 y
–hematocrit/hgb: targeted by risk assessment at 4 mo, all kids at 12 mo, then targeted at every well-child visit thereafter (added 15 and 30 month targeted screen)
–STI/HIV screen: targeted annually age 11-15, then once in all kids aged 16-18, then targeted annually thereafter (HIV screen was added in the 16-18 year range)
–cervical screen/pap: age 21, all girls. not before age 21 (consistent with other recommendations)
so, all seems reasonable to me, except i have concerns about over-testing for lipids. the real goal for the 9-11 yo screen i think is to pick up kids with severe familial dyslipidemia. i agree that many kids should be retested in late adol/early adulthood (when they are at an age to be more responsible in dietary and other lifestyle changes), though kids who actually have pristine lipids at age 9-11 and eat well/are not obese/are athletic (yes, there are some…) probably do not need a repeat lipid test 9 or 10 years later, esp girls who, even with awful diet, are pretty well protected from atherosclerotic disease until middle adulthood.
geoff