Everything from HIV to cholesterol

The American Academy of Pediatrics released new screening recommendations early last week, encouraging more preventive testing in children, everything from HIV to cholesterol.

The well-child preventive tests include:

Cholesterol

Children ages 9-11 should be screened for high blood cholesterol levels.Atherosclerosis, the fatty gunk in arteries that causes heart attacks, strokes, and other serious problems, begins while we're still young. The screening change reflects concerns about the growing epidemic of obesity in children.

"The goal is to identify risk factors early on, so we reduce their heart disease risk as adults," says author of the Paediatrics report, Dr. Geoffrey Simon, Nemours DuPont Paediatrics in Wilmington, Delaware, adding "it has nothing to do with whether your kids are obese or not."

If a 10-year-old has high cholesterol, what happens next?

Usually lifestyle and diet changes are recommended. There's a small percentage of kids whose cholesterol is just through the roof. It's not that they're overweight; genetically they have this condition. Medications like statins should be prescribed only in extreme cases.

"It is important to identify those children because you also may identify parents who may be at even more immediate risk for heart disease," says Dr. Stephen Daniels, spokesperson of the American Heart Association and chair of the Department of Pediatrics at the University of Colorado. "It is a way to not just focus on children but the whole family."

Congenital heart disease

A screening for critical congenital heart disease using pulse oximetry has been added and should be performed in the hospital before newborn discharge.

Anaemia

A risk assessment is added at 15 and 30 months for hematocrit or hemoglobin screening to help detect anemia, an iron deficiency.

Teeth

To help reduce dental cavities, the top chronic disease affecting young children, a recommendation has been added for fluoride varnish applications, given in the doctor's office, from 6 months through 5 years.

A smear (the size of a grain of rice) of toothpaste should be used up to age 3. After the 3rd birthday, a pea-sized amount may be used. Parents should dispense toothpaste for young children and supervise and assist with brushing.

Over-the counter fluoride rinse is not recommended for children younger than 6 years due to risk of swallowing higher-than-recommended levels of fluoride.

HIV testing

Teens as young as 16-18 are advised to have HIV screening at least once in a health care setting, when the prevalence of HIV in the patient popularion is more than 0.1 percent.

One in 4 new HIV infections are in 13-24 year olds and 60 percent of teens who are infected don't know it.

In areas of lower community HIV prevalence, routine HIV testing is encouraged for all sexually active adolescents and those with other risk factors for HIV.

"We decided on the range of 16 to 18 based on where you are," says Simon. "Because of local privacy laws, sometimes you can't give results confidentially to patients under 18."

While some parents may be uncomfortable with HIV screening for their teens, "it is a good idea," says Dr. Lee Beers, Medical Director for Municipal and Regional Affairs, Children's National Health System.

"We know from national surveys that adolescents are having sex and are not good about having protection," says Beers. "They don't think long term."

Depression

Suicide is the leading cause of death in adolescents, so depression screening is advised every year for ages 11-21.

Drugs and alcohol

The CRAFFT (Car, Relax, Alone, Forget, Friends, Trouble) questionnaire is recommended for all adolescents.

Doctors will ask teens:

• Have you ever ridden in a CAR driven by someone (including yourself) who was "high" or had been using alcohol or drug?

• Do you ever use alcohol or drugs to RELAX, feel better about yourself, or fit in?

• Do you ever use alcohol/drugs while you are by yourself, ALONE?

• Do you ever FORGET things you did while using alcohol or drugs?

• Do your family or FRIENDS ever tell you that you should cut down on your drinking or drug use?

• Have you gotten into TROUBLE while you were using alcohol or drugs?

Vision

The recommendation for routine vision screening at age 18 has been changed, based on evidence showing that fewer new vision problems develop in low-risk young adults.

Cervical dysplasia

Screening for the presence of pre-cancerous cells on the surface of the cervix, only at 21 years (instead of risk assessment every year from ages 11 through 21).

- Health Today