- Antibiotics should not be used for apparent viral respiratory illnesses (sinusitis, pharyngitis, bronchitis).
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.
- 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 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.
Use 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.
According to AAP President Thomas K. McInerny, MD, FAAP, “The AAP is a strong supporter of partnerships that improve the quality of care for patients. Pediatricians want the best possible tests and treatments for their patients, and they want them to be used appropriately. The Choosing Wisely campaign helps to raise awareness of the need to evaluate tests and treatments thoughtfully. This is particularly important when treating children, because they are still growing and developing.”
All of the lists released today as part of the Choosing Wisely campaign were developed by individual specialty societies after months of careful consideration and review. Using the most current evidence about management and treatment options within their specialty, the societies believe the recommendations can make a significant impact on patient care, safety and quality.
Releasing lists along with the AAP today are 16 other organizations representing more than 350,000 physicians, nurses, pathologists, radiologists and other health care professionals. They are:
- American Academy of Family Physicians*
- American Academy of Hospice and Palliative Medicine
- American Academy of Neurology
- American Academy of Ophthalmology
- American Academy of Otolaryngology—Head and Neck Surgery
- American College of Obstetricians and Gynecologists
- American College of Rheumatology
- American Geriatrics Society
- American Society for Clinical Pathology
- American Society of Echocardiography
- American Urological Association
- Society of Cardiovascular Computed Tomography
- Society of Hospital Medicine
- Society of Nuclear Medicine and Molecular Imaging
- Society of Thoracic Surgeons
- Society for Vascular Medicine
- Alliance Health Networks
- The Leapfrog Group
- Midwest Business Group on Health
- Minnesota Health Action Group
- National Business Coalition on Health
- National Business Group on Health
- National Center for Farmworker Health
- National Hospice and Palliative Care Organization
- National Partnership for Women & Families
- Pacific Business Group on Health
- Union Plus
- American Academy of Dermatology
- American Academy of Family Physicians**
- American Academy of Orthopaedic Surgeons
- American College of Rheumatology*
- American College of Surgeons
- American College of Chest Physicians
- American Headache Society
- AMDA—Dedicated to Long Term Care Medicine
- American Society of Clinical Oncology*
- American Society for Hematology
- American Society for Radiation Oncology
- American Thoracic Society
- Heart Rhythm Society
- North American Spine Society
- Society of General Internal Medicine
About the American Academy of Pediatrics
About the ABIM Foundation
About Choosing Wisely