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Is Laboratory Screening for Those Entering Foster Care Worth the Effort :

November 20, 2017

Medical examinations are required when a child enters foster care. To guide us in what should be done, including the exam and laboratory studies in 2005, the American Academy of Pediatrics (AAP) published the “Fostering Health” guidelines and subsequently a policy (reference 2 and 4).

Medical examinations are required when a child enters foster care. To guide us in what should be done, including the exam and laboratory studies in 2005, the American Academy of Pediatrics (AAP) published the “Fostering Health” guidelines and subsequently a policy (reference 2 and 4).  How often are abnormalities found in the recommended laboratory testing and what is the overall utility?  To answer these questions, Greiner et al. (10.1542/peds.2016-3778) share with us the results of the laboratory screening efforts in one county in Ohio over a 3-year period involving close to 2000 children entering foster care.  Without going into specific details that we encourage you to read for yourselves in this study, the overall yield is low suggesting that routine universal screening may not be the best option. In fact, this study suggests we need to think more about targeting our screening when the history and physical examination so indicate doing such screening.      

So in your geographic area of practice, do findings like this encourage you to think twice about universal lab screening in children being placed into foster care?  We asked adoption and foster care specialists Drs. Moira Szilagyi and Elaine Schulte to share their perspective in an accompanying commentary (10.1542/peds.2017-3075).  They argue that one study does not a policy change make but agree that this study should be the fuse that ignites other studies that may in turn result in more judicious use of laboratory studies based on key components of a child’s history or risk factors identified that would suggest doing appropriate laboratory screening.  While the AAP policy may not yet be ready to change as a result of this important study, it will hopefully foster other studies that could influence the AAP to revise its lab screening policies for this special population of children, and make you think about the value added of every laboratory study you order on your patients whether or not they are in foster care.

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