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ANEMIA

Population

  • –Infants age 6–24 mo.

Recommendations

USPSTF 2015, AAFP 2015

  • –Insufficient evidence to recommend for or against screening.

  • –Consider selective screening in high-risk childrena with malnourishment, low birth weight, or symptoms of anemia.

AAP 2010

  • –Universal screening of Hgb at 12 mo. If anemic, measure ferritin, C-reactive protein, and reticulocyte hemoglobin content.

Sources

  • –AAFP. Clinical Recommendations: Iron Deficiency Anemia. 2015.

  • –USPSTF. Iron Deficiency in Young Children: Screening. 2015.

  • Pediatrics. 2010;126(5):1040-1050.

Comments

  1. Reticulocyte hemoglobin content is a more sensitive and specific marker than is serum hemoglobin level for iron deficiency.

  2. One-third of patients with iron deficiency will have a hemoglobin level >11 g/dL.

  3. Use of transferrin receptor 1 (TfR1) assay as screening for iron deficiency is under investigation.

aIncludes infants living in poverty, Blacks, Native Americans, Alaska natives, immigrants from developing countries, preterm and low-birth-weight infants, infants whose principal dietary intake is unfortified cow’s milk or soy milk, bottle feeding beyond one year, having a mom who is currently pregnant, living in an urban area and having less than two servings per day of iron-rich foods (iron-fortified breakfast cereals or meats).

DEVELOPMENTAL DYSPLASIA OF THE HIP (DDH)

Population

  • –Infants.

Recommendations

AAP 2017, AAFP 2017

  • –Examine newborn and continue periodic surveillance physical exam for DDH including length discrepancy, asymmetric thigh or buttock creases, performing Ortolani test, and observing for limited abduction.

  • –Selective ultrasonography for “high-risk” infants 6 wk to 6 mo of age: history of breech presentation, family history, parenteral concern, history of clinical hip instability on exam, or history of lower extremity swaddling.

  • –Radiography can be considered after 4 mo of age in high-risk infants without physical exam findings or any child with positive physical exam findings.

  • –Indication for orthopedic referral: unstable or dislocated hip in physical exam. Referral does not require any prior imaging.

Comment

  1. There is evidence that screening leads to earlier identification; however, 60%–80% of the hips of newborns identified as abnormal or suspicious for DDH by physical examination, and >90% of those identified by ultrasound in the newborn period, resolve spontaneously, requiring no intervention.

Sources

  • Pediatrics. 2016;138(6):e20163107.

  • Am Fam Physician. 2017;96(3):196-197.

GROWTH ABNORMALITIES

Population

  • –Children 0–59 mo.

Recommendation

CDC 2010, AAP 2010

  • –Use the 2006 World Health Organization (WHO) international growth charts for children age <24 mo.

Sources

  • –CDC. Use of World Health Organization and CDC growth charts for children aged ...

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