Medically reviewed in May 2019
In 2017, the American Academy of Pediatrics updated its schedule of the preventive screenings children and adolescents need. The most notable changes involve testing kids for serious illnesses such as high cholesterol, depression and HIV, depending on their age. But is universal screening really necessary? We caught up with Sharecare Advisory Board Member Tanya Altmann, MD, FAAP, for her take. For a summary of what’s new in the guidelines, see the list at the end.
Several of the new recommended screenings used to be targeted to kids at risk. Why screen everybody instead?
Dr. Altmann: We used to do targeted screening and we found we were missing a lot of children and teenagers. Often the risk factors aren't apparent. With targeted screening you may miss some things, like depression or cholesterol.
The guidelines call for cholesterol tests for kids between ages 9 and 11. Do many 9-year-olds have high cholesterol, and how do you manage it?
Dr. Altmann: One of the interesting things is that these guidelines were actually approved back in 2014, so many doctors have already been following them. I've been doing cholesterol screening in my office for the last five years, and I've seen firsthand how many children are affected. They're not always overweight and they don't always have a family history of high cholesterol -- instead, their condition is due to the good ol' American diet. With screening, we're able to intervene at a young age and hopefully prevent some of the serious problems, such as heart disease, that can develop as these kids get older. Sometimes it's about making small changes: changing from fast food, switching to low-fat milk, increasing fruits and vegetables, adding exercise. But small changes like these can make a big difference.
Did any of the changes in the guidelines surprise you?
Dr. Altmann: The one that I found most surprising was the universal HIV screening. For my practice this will be the most challenging to sell to parents. Many kids aren't at risk -- or the parents don't think they are -- so the screening is going to take a little while to get used to. But the reality is that 60% of teens and young adults who have HIV don't know it, and one in four new HIV infections are in 13- to 24-year-olds. While many parents may be uncomfortable with having their child screened, based on these stats it is a good idea.
What are the recommendations for depression screening?
Dr. Altmann: Routine depression screening is officially now recommended. In the past pediatricians asked questions and sort of "read the faces” of their teen and young adult patients, and now a more standard test exists. Suicide is the leading cause of death in adolescents, so it's important to pick up those cues so we can get them help.
Fluoride varnish is recommended for kids ages 6 months to 5 years. Why is that important, since those baby teeth are just going to fall out anyway?
Dr. Altmann: Cavities in young children are a big problem nationwide. Even though they're just baby teeth, having damage early on can mean damage to permanent teeth. Applying the fluoride varnish to toddlers twice a year can decrease the rate of cavities and serious dental consequences later. It's simple to do -- it comes on a little swab and you just rub it across their teeth and gums. It kind of tastes like a toothpaste or mouthwash.
A summary of guidelines:
- Anemia screening for toddlers at 15 and 30 months, plus additional testing at other ages based on risk assessment
- Autism screening at 18 and 24 months
- Blood pressure screening at every checkup, beginning at 3 years
- BMI check at every checkup, beginning at 24 months
- Cholesterol screening for children ages 9 to 11, and again between 17 and 21
- Congenital heart disease testing in all newborns
- Fluoride varnish treatments for children ages 6 months through 5 years
- HIV testing in teens ages 15 to 18
- Annual screening for depression in young people ages 12 to 21
- Drug and alcohol risk assessment (not a drug test) for all adolescents ages 11 to 21
- Pap testing for pre-cancerous cells (cervical dysplasia) to be done in young women at age 21 (previous guidelines called for risk assessment every year from ages 11 to 21)
- Screening for sexually transmitted infections from 11 to 21, based on risk
