Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Pediatric screening tests: You can’t have it both ways

Roy Benaroch, MD
Conditions
May 28, 2014
Share
Tweet
Share

In pediatrics, almost all of our patients are healthy. We’ve got some doozies of special-needs kids, but by-and-large your ordinary pediatric patient is doing well, and does not need extensive testing or elaborate procedures to ensure good health.

Still, we do run across some occasional problems. Some children have poor vision, or hearing problems, or kidney disease, or hypothyroidism. Or autism, or Tay-Sachs Disease, or a penny up their nose. A whole lot of what we do in our checkups is easy, cheap, and quick tests to screen for these and many other problems.

Just a taste:

  • We look at height. If junior is gaining height as expected, he almost certainly doesn’t have hypothyroidism.
  • We look at blood pressure. If it’s normal, kidney disease is less likely.
  • We look in noses. Usually you can see a penny up there.
  • We test vision, using either an electronic screener, or an old fashioned chart-on-the-wall chart. Low tech, but it still works — reading the “big E” and those letters underneath is a very good screening test for vision problems.

But here’s the catch: The low tech, cheap screening tests done at the pediatrician’s office aren’t going to diagnose these conditions. They’re not meant to. These are screening tests, designed to separate the truly low-risk child from children at higher risk for genuine disease.

Children who have an elevated blood pressure are at higher risk for kidney disease — but most of them, still, don’t actually have kidney disease. Children who are growing shorter than expected might have hypothyroidism, but they probably don’t. And children who fail the vision screen may well, in fact, have good vision. But all of these children, who fail the initial screen, need more evaluation to make sure there isn’t something important going on.

Sometimes we do a poor job explaining this to parents. If your child failed our hearing screen, it doesn’t mean he is deaf, or that he even definitely has a hearing problem: It just means he might have a hearing problem, and needs further evaluation. Maybe a retest, or a more-thorough hearing test at an audiologist. The follow-up testing might be normal, and that would be good news.

We’ve had some parents getting angry when their follow-up tests are normal: “It was a waste of time and money! We didn’t need to go to the eye doctor!”

Well, I’m sorry if we explained that poorly. A screening test is a screening test. I can’t say for sure whether junior really needs glasses, but I can say which kids need more evaluation. I don’t think a thorough eye exam that ends with a reassuring result is a waste of time.

Why screen at all? I mean, why not just have every child undergo a thorough eye test at the ophthalmologist, and a full audiology exam, and an EKG and echocardiogram and renal ultrasound and every blood test in the book and a weekly whole body MRI and a two week intense neuropsychiatric evaluation and brain biopsy? Because that would be expensive, and that would be torture, and it still wouldn’t rule in or out every possible disease.

Look at it this way: If we set the bar so high that everyone who failed the screen really had disease, that would mean many people who didn’t fail the screen really do have disease. In an inexact world, you can’t have it both ways. There’s a grey zone there, and screening tests are designed to catch children who “might” have disease, meaning they also catch kids who really don’t. Screening tests aren’t meant to confirm disease. They’re meant to catch the kids who need more evaluation to be sure they’re fine.

Roy Benaroch is a pediatrician who blogs at The Pediatric Insider. He is also the author of Solving Health and Behavioral Problems from Birth through Preschool: A Parent’s Guide and A Guide to Getting the Best Health Care for Your Child.

Prev

How do we fix the high blood pressure problem?

May 28, 2014 Kevin 4
…
Next

Cancer care for international patients

May 28, 2014 Kevin 0
…

Tagged as: Pediatrics

Post navigation

< Previous Post
How do we fix the high blood pressure problem?
Next Post >
Cancer care for international patients

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by Roy Benaroch, MD

  • Goodbye, Benadryl: It is time for you to retire

    Roy Benaroch, MD
  • Telemedicine overprescribes antibiotics: Are you really receiving the best care over the phone?

    Roy Benaroch, MD
  • No, phones don’t cause horns to grow on skulls

    Roy Benaroch, MD

More in Conditions

  • 5 cancer myths that could delay your diagnosis or treatment

    Joseph Alvarnas, MD
  • When bleeding disorders meet IVF: Navigating von Willebrand disease in fertility treatment

    Oluyemisi Famuyiwa, MD
  • What one diagnosis can change: the movement to make dining safer

    Lianne Mandelbaum, PT
  • How kindness in disguise is holding women back in academic medicine

    Sylk Sotto, EdD, MPS, MBA
  • Measles is back: Why vaccination is more vital than ever

    American College of Physicians
  • Hope is the lifeline: a deeper look into transplant care

    Judith Eguzoikpe, MD, MPH
  • Most Popular

  • Past Week

    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education
    • Physician patriots: the forgotten founders who lit the torch of liberty

      Muhamad Aly Rifai, MD | Physician
    • The hidden cost of becoming a doctor: a South Asian perspective

      Momeina Aslam | Education
    • Why fixing health care’s data quality is crucial for AI success [PODCAST]

      Jay Anders, MD | Podcast
    • Closing the gap in respiratory care: How robotics can expand access in underserved communities

      Evgeny Ignatov, MD, RRT | Tech
    • Reclaiming trust in online health advice [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • How dismantling DEI endangers the future of medical care

      Shashank Madhu and Christian Tallo | Education
    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
  • Recent Posts

    • Why fixing health care’s data quality is crucial for AI success [PODCAST]

      Jay Anders, MD | Podcast
    • Why so many physicians struggle to feel proud—even when they should

      Jessie Mahoney, MD | Physician
    • If I had to choose: Choosing the patient over the protocol

      Patrick Hudson, MD | Physician
    • How a TV drama exposed the hidden grief of doctors

      Lauren Weintraub, MD | Physician
    • Why adults need to rediscover the power of play

      Anthony Fleg, MD | Physician
    • How collaboration across medical disciplines and patient advocacy cured a rare disease [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education
    • Physician patriots: the forgotten founders who lit the torch of liberty

      Muhamad Aly Rifai, MD | Physician
    • The hidden cost of becoming a doctor: a South Asian perspective

      Momeina Aslam | Education
    • Why fixing health care’s data quality is crucial for AI success [PODCAST]

      Jay Anders, MD | Podcast
    • Closing the gap in respiratory care: How robotics can expand access in underserved communities

      Evgeny Ignatov, MD, RRT | Tech
    • Reclaiming trust in online health advice [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • How dismantling DEI endangers the future of medical care

      Shashank Madhu and Christian Tallo | Education
    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
  • Recent Posts

    • Why fixing health care’s data quality is crucial for AI success [PODCAST]

      Jay Anders, MD | Podcast
    • Why so many physicians struggle to feel proud—even when they should

      Jessie Mahoney, MD | Physician
    • If I had to choose: Choosing the patient over the protocol

      Patrick Hudson, MD | Physician
    • How a TV drama exposed the hidden grief of doctors

      Lauren Weintraub, MD | Physician
    • Why adults need to rediscover the power of play

      Anthony Fleg, MD | Physician
    • How collaboration across medical disciplines and patient advocacy cured a rare disease [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...