Doctors should test middle school-age
children for high cholesterol and start screening for depression at age 11,
according to updated guidelines from a leading group of US paediatricians.
Doctors should also test older teens for
HIV, the Aids-causing virus, the revised preventive-care recommendations from
the American Academy of Paediatrics say.
The new screening schedule provides
"the recommended content for a well-child visit", said Dr Joseph
Hagan, co-editor of the guidelines. "Some changes are small, some will get
The changes attempt to address several pressing
health issues affecting US families today. The nation's obesity epidemic means
that children are developing high cholesterol levels – a risk factor for heart
disease – at earlier ages. And depression is linked to higher risk for teen
suicides and murder.
may help depressive kids
5 kids will meet depression criteria
"One in five kids will, at some point
in time, meet the criteria for depression," said Hagan, a professor in paediatrics
at the University of Vermont College of Medicine.
Here are the most significant changes to
the guidelines, published online in the journal Paediatrics:
screening at ages 11 through 21. If depression seems likely after asking
suggested questions, doctors should assess its severity and make appropriate
referrals to a social worker or psychologist for further evaluation and
treatment. In some cases, a paediatrician might prescribe antidepressants, said
depression may be a heart risk
Firearms a problem
The key question to ask parents of a child
diagnosed with depression and suicidal thinking is if they have firearms in the
home. "If the answer is yes, you have to ask parents to please remove the
firearms to someone else's home," he said.
"Do not try to lock them up. Or keep
the ammunition separate from the gun. A smart, determined adolescent will get
Cholesterol screening between ages 9 and
11: Hormonal changes make it difficult to get an accurate cholesterol reading
during adolescence, so the doctors' group recommends screening before puberty's
Lifestyle changes, rather than medication,
usually will be recommended to control elevated cholesterol levels, thus
reducing potential heart risks, Hagan said.
These include eating healthier foods and
getting more exercise. A cholesterol screen at this age also can catch
cholesterol conditions that are passed down from parents, Hagan said.
HIV screening between 16 and 18 years old:
The earlier you diagnose someone with HIV, the sooner essential treatment
starts, said Hagan. New medications can keep someone symptom-free for many
years. "By diagnosing early, we can change the course of the
disease," said Hagan.
Critical congenital heart disease screening
for all newborns: An oxygen saturation test called pulse oximetry should be
performed on all newborns. Hagan said this is already the standard of care; the
academy just formalised the recommendation. But no Pap smears and checking for
precancerous cervical changes in girls before age 21.
care may help kids of depressed moms
Research showed that it was "not
unusual to find abnormalities", said Hagan. The problem was, those
abnormalities often never amounted to anything serious. But additional tests,
such as biopsies, were frequently done, needlessly raising costs and anxiety.
Because the new recommendations "were
carefully vetted for the presence of medical evidence, most insurers already
cover them," Hagan said. And they are also covered under most plans in the
Affordable Care Act.
The updates didn't come as a surprise, said
one children's doctor.
"Many of these changes were ones we
anticipated," said Dr Kristin Hannibal, clinic director of the Primary
Care Centre at Children's Hospital of Pittsburgh. "The major stumbling
block is always how do we take these recommendations and implement them across
Formalisation of the recommendations will
make it easier to obtain insurance reimbursement, Hannibal said. Hagan said
that parents should feel empowered to ask their paediatricians if they're
following the Bright Futures guidelines.
"If a practice isn't following the
guidelines, parents can encourage them to do so," suggested Hagan.
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