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New Guidelines: All Kids Should Have Cholesterol, Depression, and HIV Screening

The Short of It

Doctors should now screen all kids for high cholesterol, depression, and HIV, with some tests starting as early as age 9, according to the guidelines released by the American Academy of Pediatrics today in the journal "Pediatrics."

The Lowdown

Your next pediatrician's visit may last a little longer, because the American Academy of Pediatrics is revamping its screening recommendations, which call for more preventative testing for everything from HIV and depression to anemia and cholesterol.

Here's the run-down of all the changes:

Anemia

A risk assessment has been added at 15 and 30 months for a hematocrit or hemoglobin screen to help detect iron deficiency.

Congenital Heart Disease

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

Cholesterol

All children ages 9-11 should be screened for high blood cholesterol levels—not just those who are considered high risk, like the previous guidelines stated. The update reflects concerns about the growing epidemic of obesity in children, as well as the fact that targeted screening can miss too many children with abnormalities.

"The goal is to identify risk factors early on, so we reduce their heart disease risk as adults," said report author Dr. Geoffrey Simon of Nemours DuPont Pediatrics. "It has nothing to do with whether your kids are obese or not."

Depression

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

"We're trying to get to kids before they reach the point where they might need medication," Simon said.

HIV Testing

One in 4 new HIV infections are found in 13 to 24-year-olds and 60 percent of teens who are infected don't know it. Now 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 population is more than 0.1 percent. 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 know from national surveys that adolescents are having sex and are not good about having protection," said Dr. Lee Beers, Medical Director for Municipal and Regional Affairs, Children's National Health System. "They don't think long term."

Teeth

To help reduce dental cavities, a recommendation has been added for fluoride varnish applications to be given in the doctor's office, from 6 months through 5 years. And while just a smear—about the size of a grain of rice—of toothpaste should be used up to age 3, that amount should be increased to the size of a pea after a child's third birthday. Parents should dispense it for young children and supervise brushing.

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

Instead of doing a risk assessment every year from ages 11 through 21, screening for the presence of pre-cancerous cells on the surface of the cervix is recommended to start at 21 years old.

Drugs and Alcohol

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

The Upshot

As a parent, you may feel wary about some of these new guidelines, especially since you might be asked to leave the room on occasion so the doctor can speak with your child more freely. Don't be alarmed. Just remember that these screenings are preventative in nature, and that you and your pediatrician are working toward the same goal: to provide the best possible health care for your child.

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