MONDAY, Feb. 24, 2014 (HealthDay News) -- 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 U.S. pediatricians.
Doctors should also test older teens for HIV, the AIDS-causing
virus, the revised preventive-care recommendations from the
American Academy of Pediatrics 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 people's
The changes attempt to address several pressing health issues
affecting U.S. 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.
"One in five kids will, at some point in time, meet the criteria for depression," said Hagan, a professor in pediatrics at the University of Vermont College of Medicine.
Here are the most significant changes to the guidelines,
published online Feb. 24 in the journal
Depression 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 pediatrician might prescribe antidepressants, said
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 to them."
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
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 formalized the
No Pap smears and checking for precancerous cervical changes in
girls before age 21.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
"Many of these changes were ones we anticipated," said Dr. Kristin Hannibal, clinic director of the Primary Care Center at Children's Hospital of Pittsburgh. "The major stumbling block is always how do we take these recommendations and implement them across the board."
Formalization of the recommendations will make it easier to
obtain insurance reimbursement, Hannibal said.
Hagan said that parents should feel empowered to ask their
pediatricians if they're following the Bright Futures
"If a practice isn't following the guidelines, parents can encourage them to do so," suggested Hagan.
Learn more about what to expect at well-child visits from the
U.S. National Library of Medicine.
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