The American Academy of Pediatrics (AAP) – Section on Endocrinology recently released five Choosing Wisely recommendations to facilitate conversations between clinicians and parents about endocrine-related tests that may not be necessary for children who are otherwise healthy.
The new list includes five tests commonly ordered when a parent is concerned that a child is too short, entering puberty too early, overweight, or has an enlarged thyroid, as well as evidence-based strategies for determining when these tests would not benefit a child, or possibly cause harm.
“As a pediatric endocrinologist, I’ve counseled many parents who are worried about their children’s growth,” Paul Kaplowitz, MD, PhD, FAAP, past chairperson of the AAP Section on Endocrinology, said in a news release about the list. “There is a wide range of what is ‘normal’ for child growth and development. If a child is otherwise healthy and is following their own curve, what the parents often need is reassurance that their child is fine, and not a lot of testing.”
AAP has provided the following recommendations and evidence supporting them:
- Avoid ordering LH and FSH and either estradiol or testosterone for children with pubic hair and/or body odor but no other signs of puberty.
- Avoid routinely measuring thyroid function and/or insulin levels in children with obesity.
- Avoid routinely ordering thyroid ultrasounds in children who have simple goiters or autoimmune thyroiditis.
- Avoid ordering Vitamin D concentrations routinely in otherwise healthy children, including children who are overweight or obese.
- Avoid ordering screening tests looking for chronic illness or an endocrine cause, including CBC, CMP, IGF-1, thyroid tests, and celiac antibodies, in healthy children who are growing at or above the 3rd percentile for height with a normal growth rate (i.e., not crossing percentiles) and with appropriate weight gain.