The American Academy of Pediatrics released new screening recommendations Monday, December 7, 2015. These include new guidelines for fluoride. This article will review the guidelines, why they are being updated, and what pediatricians will be looking for during screening. (1)
Cholesterol: Children ages nine to 11 should be screened for high blood cholesterol levels. The screening change reflects the growing epidemic of obesity in children. The goal of this recommendation is to identify risk factors early and to hopefully reduce heart disease risk in adults. If a child is diagnosed with high cholesterol, lifestyle and diet changes are most often recommended. However, a small percentage of children in this category have extremely high cholesterol, are not overweight, and are genetically predisposed to this condition. Medications like statins would be prescribed only in extreme cases. (2)
Congenital heart disease and anemia: A screening for critical congenital heart disease using pulse oximetry has been added to the guidelines and should be performed in the hospital before newborn discharge. A risk assessment at 15 and 30 months for hematocrit or hemoglobin screening to help detect anemia, an iron deficiency, has also been added.
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Fluoride varnish: A recommendation has been added for fluoride varnish applications, given in the physician's office, from six months through five years of age. A smear (the size of a grain of rice) of toothpaste should be used up to age three. After the third 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 six years due to risk of swallowing higher-than-recommended levels of fluoride.
HIV: The new guidelines address HIV testing and suggest that teenagers, from 16–18 tears of age, have HIV screening at least once in a health care setting. This is recommended when the prevalence of HIV in the patient population is more than 0.1%. According to the report, one in four new HIV infections are in 13–24 year-old teenagers, and 60% of teens who have HIV are not aware that they are infected. In regions of lower community HIV prevalence, routine HIV testing is encouraged for all sexually active adolescents and those with other risk factors for HIV.
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Depression: As suicide is the leading cause of death in adolescents, depression screening is advised every year for ages 11-21. (3)
Substance abuse: Regarding drugs and alcohol, the CRAFFT (Car, Relax, Alone, Forget, Friends, Trouble) questionnaire is recommended for all adolescents. (4) CRAFFT is a mnemonic acronym of first letters of key words in the six screening questions. The questions should be asked exactly as written.
C - Have you ever ridden in a CAR driven by someone (including yourself) who was "high" or had been using alcohol or drugs?
R - Do you ever use alcohol or drugs to RELAX, feel better about yourself, or fit in?
A - Do you ever use alcohol/drugs while you are by yourself, ALONE?
F - Do you ever FORGET things you did while using alcohol or drugs?
F - Do your family or FRIENDS ever tell you that you should cut down on your drinking or drug use?
T - Have you gotten into TROUBLE while you were using alcohol or drugs? (4)
Vision: There is a suggestion that the recommendation for routine vision screening at age 18 be changed, based on evidence showing that fewer new vision problems develop in low-risk young adults.
Cervical cancer: Regarding 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), is in the new guidelines.
For more information, visit the American Academy of Pediatrics.
References
1. AAP Releases Summary of Updated Preventive Health Care Screening and Assessment Schedule for Children's Checkups. American Academy of Pediatrics website. https://www.aap.org/en-us/about-the-aap/aap-press-room/Pages/AAP-Releases-Summary-of-Updated-Preventive-Health-Care-Screening-and-Assessment-Schedule-for-Children's-Checkups.aspx. Published December 7, 2015. Accessed December 16, 2015.
2. 2016 Recommendations for Preventive Pediatric Health Care. AAP Gateway. http://pediatrics.aappublications.org/content/early/2015/12/07/peds.2015-3908. Accessed December 16, 2015.
3. Fact stats: Adolescent health. CDC website. http://www.cdc.gov/nchs/fastats/adolescent-health.htm. Updated September 30, 2015. Accessed December 16, 2015.
4. The CRAFFT screening tool. The Center of Adolescent Substance Abuse Research website. http://www.ceasar-boston.org/CRAFFT/index.php. Accessed December 16, 2015.
