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When Are We Doing Too Much? Looking at Medical Overuse in Pediatrics

January 21, 2022

Since 2013, the AAP’s Choosing Wisely initiative has highlighted therapies that are not truly necessary, evidence-based, and/or potentially harmful—these have included the use of antibiotics for viral upper respiratory infections, use of cough and cold medicines, neuroimaging for simple febrile seizures, and apnea monitors to prevent SIDS. Are there additional therapies that, based on evidence, are ones about which we should think twice before using?

This week, Pediatrics is early releasing an article entitled, “2021 Update on Pediatric Overuse,” by Dr. Nathan Money at the University of Utah and his colleagues at Stanford, Baylor, Beth Israel Deaconess, University of Pittsburgh, Virginia Commonwealth, University of Maryland, and UC-San Francisco (10.1542/peds.2021-053384). The authors define “pediatric overuse” as pediatric “healthcare that provides no net benefit to patients, is associated with significant costs, and potential harm to patients.”

The authors reviewed the medical literature from 2019 and 2020 and scored 31 articles as being highly impactful, presumably since the practices described are so common.

There are too many articles to discuss in this blog, and so I refer you to the paper and supplementary table 2 so that you can review all of them.

However, we should think twice about a few of these therapies before we decide to use them, including:

  • Platelet and red blood cell transfusions in the NICU
  • Aggressive treatment of neonatal hypoglycemia
  • Adenotonsillectomy for preschoolers who have obstructive sleep apnea
  • Chest tubes for children with primary spontaneous pneumothorax
  • Diagnosis and medical treatment of attention deficit-hyperactivity disorder in children who are younger than the peers in their grade

As physicians, we often feel we need to ‘do something.’ This article reminds us that sometimes it may be better to take a ‘watch and wait’ approach.

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