Although overall antibiotic prescription rates for children have fallen, they still remain alarmingly high. Unnecessary medication use for viral respiratory illnesses can lead to antibiotic resistance and contributes to higher health care costs and the risks of adverse events.
American Academy of Pediatrics
Five Things Physicians and Patients Should QuestionDownload PDF
Antibiotics should not be used for apparent viral respiratory illnesses (sinusitis, pharyngitis, bronchitis).
Cough and cold medicines should not be prescribed or recommended for respiratory illnesses in children under four years of age.
Research has shown these products offer little benefit to young children and can have potentially serious side effects. Many cough and cold products for children have more than one ingredient, increasing the chance of accidental overdose if combined with another product.
Computed tomography (CT) scans are not necessary in the immediate evaluation of minor head injuries; clinical observation/Pediatric Emergency Care Applied Research Network (PECARN) criteria should be used to determine whether imaging is indicated.
Minor head injuries occur commonly in children and adolescents. Approximately 50% of children who visit hospital emergency departments with a head injury are given a CT scan, many of which may be unnecessary. Unnecessary exposure to x-rays poses considerable danger to children, including increasing the lifetime risk of cancer because a child’s brain tissue is more sensitive to ionizing radiation. Unnecessary CT scans also impose undue costs to the health care system. Clinical observation prior to CT decision-making for children with minor head injuries is an effective approach.
Neuroimaging (CT, MRI) is not necessary in a child with simple febrile seizure.
CT scanning is associated with radiation exposure that may escalate future cancer risk. MRI also is associated with risks from required sedation and high cost. The literature does not support the use of skull films in the evaluation of a child with a febrile seizure. Clinicians evaluating infants or young children after a simple febrile seizure should direct their attention toward identifying the cause of the child’s fever.
Computed tomography (CT) scans are not necessary in the routine evaluation of abdominal pain.
Utilization of CT imaging in the emergency department evaluation of children with abdominal pain is increasing. The increased lifetime risk for cancer due to excess radiation exposure is of special concern given the acute sensitivity of children’s organs. There also is the potential for radiation overdose with inappropriate CT protocols.
For more information, visit www.aap.org.
How this list was created: The American Academy of Pediatrics (AAP) employed a three-stage process to develop its list. Using the Academy’s varied online, print and social media communication vehicles, the first stage invited leadership of the Academy’s 88 national clinical and health policy-driven committees, councils and sections to submit potential topics via an online survey. The second stage involved expert review and evaluation of the management groups that oversee the functions of the committees, councils and sections. Based on a set of criteria (evidence to document unproven clinical benefit, potential to cause harm, over-prescribed and utilized, and within the purview of pediatrics) a list of more than 100 topics was narrowed down to five. Finally, the list was reviewed and approved by the Academy’s Board of Directors and Executive Committee.
AAP’s disclosure and conflict of interest policy can be found at www.aap.org.
American Academy of Pediatrics. Subcommittee on diagnosis and management of bronchiolitis. Pediatrics [Internet]. 2006 Oct;118(4):1774-93.
Kelly LF. Pediatric cough and cold preparations. Pediatrics Rev. 2004 April;25(4):115-123.
O’Brien KL, Dowell SF, Schwartz B, Marcy SM, Phillips WR, Gerber MA. Cough illness/bronchitis – principles of judicious use of antimicrobial agents. Pediatrics [Internet]. 1998;101(supplement):178-81.
Shulman ST, Bisno AL, Clegg HW, Gerber MA, Kaplan EL, Lee G, Martin JM, Van Benden C. Clinical practice guideline for the diagnosis and management of Group A Streptococcal Pharyngitis: 2012 update by the Infectious Diseases Society of America. Clin Infect Dis.[Internet]. 2012 Sep 9. Dopi:10.1093/cid/cis629.
Williamson IG, Rumsby K, Benge S, Moore M, Smith PW, Cross M, Little P. Antibiotics and topical nasal steroids for treatment of acute maxillary sinusitis: A randomized controlled trial. JAMA [Internet]. 2007;298(21):2487-96.
Carr BC. Efficacy, abuse, and toxicity of over-the-counter cough and cold medications in the pediatric population. Currt Opin Pediatrics. 2006 Apr;18(2):184-88.
Irwin RS, Baumann MH, Bolser DC, Boulet LP, Braman SS, Brightling CE, Brown KK, Canning BJ, Chang AB, Dicpinigaitis PV, Eccles R, Glomb WB, Goldstein LB, Graham LM, Hargreave FE, Kvale PA, Lewis SZ, McCool FD, McCrory DC, Prakash UB, Pratter MR, Rosen MJ, Schulman E, Shannon JJ, Smith Hammond C, Tarlo SM; American College of Chest Physicians (ACCP). Diagnosis and management of cough executive summary: ACCP evidence-based clinical practice guidelines. Chest. 2006 Jan;129(1_suppl):1S-23S.
Isbister GK, Prior F, Kilham HA. Restricting cough and cold medications in children. J Paediatr Child Health [Internet] 2012 Feb;48(2):91-8.
Schaeffer MK, Shehab N, Cohen AL, Budnitz DS. Adverse events from cough and cold medication in children. Pediatrics [Internet]. 2008 Apr;121(4):783-87.
Sharfstein JM, North M, Serwint JR. Over the counter but no longer under the radar – pediatric cough and cold medications. N Eng J Med [Internet]. 2007 Dec 6;357(23):2321-4.
Dunning J, Batchelor J, Stratford-Smith P, Teece S, Browne J, Sharpin C, Mackway-Jones K. A meta-analysis of variables that predict significant intracranial injury in minor head trauma. Arch Dis Child [Internet]. 2004 Jul;89(7):653-9.
Kuppermann N, Holmes, JF, Dayan PS, Hoyle JD Jr, Atabaki SM, Holubkov R, Nadel FM, Monroe D, Stanley RM, Borgialli DA, Badawy MK, Schunk JE, Quayle KS, Mahajan P, Lichenstein R, Lillis KA, Tunik MG, Jacobs ES, Callahan JM, Gorelick MH, Glass TF, Lee LK, Bachman MC, Cooper A, Powell EC, Gerardi MJ, Melville KA, Muizelaar JP, Wisner DH, Zuspan SJ, Dean JM, Wootton-Gorges SL; Pediatric Emergency Care Applied Research Network (PECARN). Identification of children at very low-risk of clinically-important brain injuries after head trauma: A prospective cohort study. Lancet [Internet]. 2009 Oct;374(9696):1160-70.
Nigrovic LE, Schunk JE, Foerster A, Cooper A, Miskin M, Atabaki SM, Hoyle J, Dayan PS, Holmes JF, Kuppermann N, Traumatic Brain Injury Group for the Pediatric Emergency Care Applied Research Network. The effect of observation on cranial computed tomography utilization for children after blunt head trauma. Pediatrics [Internet]. 2011 Jun;127(6):1067-1073.
Oman JA, Cooper RJ, Holmes JF, Viccellio P, Nyce A, Ross SE, Hoffman JR, Mower WR. Performance of a decision-rule to predict need for computed tomography among children with blunt head trauma. Pediatrics [Internet]. 2006 Feb;117(2):e238-46.
American Academy of Pediatrics. Subcommittee on Febrile Seizures. Febrile seizures: Guideline for the neurodiagnostic evaluation of the child with a simple febrile seizure. Pediatrics [Internet]. 2011 Feb;127(2):389-394.
Brenner DJ, Hall EJ. Computed tomography – an increasing risk of radiation exposure. N Eng J Med [Internet]. 2007 Nov 29;357:2277-2284.
Burr A, Renaud EJ, Manno M, Makris J, Cooley E, DeRoss A, Hirsh M. Glowing in the dark: Time of day as a determinant of radiographic imaging in the evaluation of abdominal pain in children. J Pediatr Surg [Internet]. 2011 Jan;46(1):188-191.
Kim K, Kim YH, Kim SY, Lee YJ, Kim KP, Lee HS, Ahn S, Kim T, Hwang SS, Song KJ, Kang SB, Kim DW, Park SH, Lee KH. Low-dose abdominal CT for evaluating suspected appendicitis. N Engl J Med [Internet]. 2012 Apr 26;366:1596-1605.
Stewart K, Olcott W. Jeffrey RB. Sonography for appendicitis: Nonvisualization of the appendix is an indication for active clinical observation rather than direct referral for computed tomography. J Clin Ultrasound [Internet]. 2012 Oct;40(8):455-61.
Pearce MS, Salotti JA, Little MP, McHugh K, Lee C, Kim KP, Howe NL, Ronckers CM, Rajaraman P, Craft AW, Parker L, Berrington de González A. Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: A retrospective cohort study. Lancet [Internet] 2012 Aug 4;380(9840):499-505.
Saito JM. Beyond appendicitis: Evaluation and surgical treatment of pediatric acute abdominal pain. Curr Opin Pediatr [Internet]. 2012 Jun;24(3):357-364.