Pediatrics: Screenings and Developmental Care

INTRODUCTION

THE MANAGEMENT OF MEDICAL CONDITIONS IN THE PEDIATRIC POPULATION IS ADDRESSED IN THOSE CONDITIONS’ RESPECTIVE CHAPTERS.

ALCOHOL ABUSE AND DEPENDENCE

Screening

Children and Adolescents

Recommendations from

► AAFP 2010, USPSTF 2018, ICSI 2010

–There is insufficient evidence to recommend for or against screening or counseling interventions to prevent or reduce alcohol misuse by adolescents.

Practice Pearls

AUDIT and CAGE questionnaires have not been validated in children or adolescents.
Screen using a tool designed for adolescents, such as the CRAFFT, BSTAD, or S2BI.
Reinforce not drinking and driving or riding with any driver under the influence.
While behavioral counseling has been proven to be beneficial in adults, data do not support its benefit in adolescents.
Ask about friends’ alcohol use.

Sources

–USPSTF. Unhealthy Alcohol Use in Adolescents and Adults: Screening and Behavioral Counseling Interventions. 2018.
–https://www.icsi.org/guidelines_more/catalog_guidelines_and_more/catalog_guidelines/
–Ann Fam Med. 2010;8(6):484–492.

ANEMIA

Screening

Newborns, Infants, and Children

Recommendations from

► USPSTF 2015, AAFP 2015, AAP 2017

–See Guidelines Alert 16–1 for discussion of screening for pediatric anemia.

Guidelines Alert 16–1Guidelines Discordant: Whether to Screen Routinely for Anemia

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Guidelines Alert 16–1 Guidelines Discordant: Whether to Screen Routinely for Anemia

Organization

Guidance

AAFP, USPSTF

Insufficient evidence to recommend for or against screening infants and newborns

Consider selective screening in high-risk children^a with malnourishment, low birth weight, or symptoms of anemia

AAP

Universal screening of Hgb at 12 mo

Applying to Clinical Practice

The AAP recommends screening because iron deficiency anemia can lead to neurodevelopmental harm.
USPSTF notes that more study is needed to identify ideal screening tests and show that iron supplementation improves clinical outcomes in those who screen positive.
Harms of screening include false-positive results, discomfort to patient, and cost.
Harms of treatment with oral iron include GI upset, staining of teeth and gums, and the potential for drug interactions or iron overdose.
Given the manageable harms and potential for poor outcomes, it is reasonable to screen universally until better data are available, especially in higher-risk settings.

^aIncludes infants living in poverty, Black persons, Alaska Native persons, immigrants from developing countries, preterm and low-birth-weight infants, infants whose principal dietary intake is unfortified cow’s milk or soy milk, bottle feeding beyond 1 y, having a mom who is currently pregnant, living in an urban area and having less than 2 servings per day of iron-rich foods (iron-fortified breakfast cereals or meats).

Practice Pearls

If anemic, measure ferritin, C-reactive protein, and reticulocyte hemoglobin content. Reticulocyte hemoglobin content is a more sensitive and specific marker ...

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Chapter 16: Pediatrics: Screenings and Developmental Care

Citation

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INTRODUCTION

ALCOHOL ABUSE AND DEPENDENCE

Screening

Recommendations from

Sources

ANEMIA

Screening

Recommendations from

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