{"id":297,"date":"2014-03-02T02:25:10","date_gmt":"2014-03-02T02:25:10","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/?p=297"},"modified":"2017-08-21T13:00:04","modified_gmt":"2017-08-21T13:00:04","slug":"primary-care-corner-with-geoffrey-modest-md-new-pediatric-preventative-health-recs","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2014\/03\/02\/primary-care-corner-with-geoffrey-modest-md-new-pediatric-preventative-health-recs\/","title":{"rendered":"Primary Care Corner with Geoffrey Modest MD: New pediatric preventative health recs"},"content":{"rendered":"

the am acad of pediatrics just came out with new pediatric preventive care guidelines (see\u00a0http:\/\/pediatrics.aappublications.org\/content\/early\/2014\/02\/18\/peds.2013-4096.full.pdf<\/a>).\u00a0the 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:\u00a0<\/p>\n

development\/behavior:<\/p>\n

–depression screen yearly from ages 11 through 21, esp using PHQ-2\u2028
–alcohol and drug screen yearly from ages 11 through 21, esp using CRAFFT (this is to do targeted assessment, with appropriate action if positive)<\/p>\n

procedures:<\/p>\n

–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\u2028
–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)\u2028\u00a0
–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)
\u2028–cervical screen\/pap: age 21, all girls. not before age 21 (consistent with other recommendations)<\/p>\n

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.<\/p>\n

geoff<\/p>\n","protected":false},"excerpt":{"rendered":"

the am acad of pediatrics just came out with new pediatric preventive care guidelines (see\u00a0http:\/\/pediatrics.aappublications.org\/content\/early\/2014\/02\/18\/peds.2013-4096.full.pdf).\u00a0the 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:\u00a0 development\/behavior: –depression screen yearly from ages 11 through 21, esp […]<\/p>\n

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