From the moment they're born, children's growth patterns are a huge concern for parents and doctors alike. And as your child gets older, you may wonder: Is he too short? Is she hitting puberty too early? Is he overweight? But as it turns out, doctors may be too quick to order testing based on these concerns, according to a new report from the American Academy of Pediatrics (AAP), part of the Choosing Wisely campaign to reduce unnecessary testing. The guidelines offer up five growth-related tests that doctors can often skip—saving time, money and a whole lot of worry.
Why these specific tests? "They represent examples of tests that are used too often and add little or no value to patient care but add a lot of cost," Paul Kaplowitz, M.D., Ph.D., past chairperson of the AAP Section on Endocrinology, which compiled the evidence-based list, tells Parents.com. "In many cases these tests are ordered by primary care providers before the child has been seen by a specialist who can decide if testing would be helpful, and if so which tests provide the most useful information." Growth encompasses a wide range of normal, he adds, so if the child is healthy, searching for problems isn't usually necessary.
The tests are:
1. Hormone tests for early puberty
In the instance that a child has only developed pubic hair or body odor but has no other signs of puberty or sexual maturation (like breast development in girls, or rapid growth), these tests can be skipped.
2. Screening tests for endocrine disorders in short kids
In healthy kids who are growing at a normal rate and have no other problems, the AAP says these tests only reveal an underlying problem one percent of the time—even in children who are below the third percentile for height. But if a child has significantly short stature especially if his parents are tall, the AAP recommends tiered screening instead of a bunch of tests all at once.
3. Vitamin D screening
Even in obese children, who often have low vitamin D levels, the AAP says this test can be skipped—instead, just giving a vitamin D supplement is a cost-effective option with no testing required. Screening for vitamin D is only recommended for kids with disorders linked with low bone mass, like rickets, or a history of bone fractures.
4. Thyroid and insulin tests
For children with obesity, the AAP says these tests aren't needed. Measuring insulin levels doesn't affect how doctors treat obese patients; and thyroid testing should only be considered if the growth rate is below normal or there are other signs of a thyroid issue.
5. Routine thyroid ultrasounds
For children who do have an enlarged thyroid (also known as a goiter) or autoimmune thyroiditis, routine ultrasound testing of the thyroid isn't necessary, unless the goiter is very big, the child has swelling on only side of her neck, or nodules that can be felt by hand.
Too much testing can uncover unusual findings that aren't really problems but that lead to more testing, Dr. Kaplowitz explains. "All to often, one or more of the tests are slightly abnormal in a way which does not need treatment, but results in even more testing and parental anxiety," he says.
It's especially common for parents to have concerns if their children are short—but chances are, that's just how nature made them. "Sometimes unnecessary tests, when normal, can reassure anxious parents and physicians," Dr. Kaplowitz says. But, "when a child is healthy, only mildly short ,and growing at a normal rate, there is very little chance that a battery of tests will turn up a medical condition which explains why the child is short."
Still, if you're concerned about your child's growth, by all means bring it up to your doctor. "Their pediatrician will usually discuss any concerns they may have and decide if a referral to a specialist is needed," Dr. Kaplowitz says. For more resources, you can also visit the "Glands and Growth" section of the AAP's site for parents, healthychildren.org.