Of course parents want their children to receive the most comprehensive, up-to-date and highest-quality medical care available. But medical researchers are finding that in a rush to adopt new medical practices and safeguard children’s health, providers may sometimes do more harm than good.
A systematic review published this month in the Journal of the American Medical Association Pediatrics highlights pediatric medical practices that may be unwarranted and could harm children’s health, instead of improving it.
To conduct the review, a team of pediatric researchers evaluated all medical research articles related to overuse of pediatric medical care published in 2018, and scored each article for its research quality and impact. Researchers used this system to identify the most pressing issues regarding pediatric medical overuse.
One of the top issues was the misdiagnosis of attention deficit hyperactivity disorder, or ADHD.
A top-rated study in the review followed more than 400,000 students in states where children must turn 5 years old before September 1 to begin kindergarten. The researchers found that children born in August, essentially the youngest children in their grade, were 34 percent more likely to be diagnosed with ADHD compared to children born in September, who were among the oldest in their grade. The younger children were also more likely take behavioral medications for ADHD and more likely to stay in therapy for a longer period of time.
The take-home message is that some children may be mis-diagnosed and overtreated for ADHD because they are relatively immature compared to the other kids in their class.
Another top-rated study looked at medical data for youth with chronic illnesses in the state of Tennessee over a 15-year period. They found that 15 percent of children with Medicaid insurance coverage (which is for low-income and chronically sick children) received opioid prescriptions for a wide range of medical issues including dental procedures, outpatient surgery, trauma and infections.
A fraction of those children – approximately 39 out of 100,000 – experienced adverse events as a result of taking the opioids. The key part of the article is that more than 70 percent of the children who experienced adverse events were following their doctors’ instructions when taking the medicines. As a result, and given the addictive nature of opioids, the researchers recommend different types of pain relievers for youth whenever possible.
A third top-rated article looked at whether it’s worthwhile to have nurses visit children after they have been hospitalized for complicated medical conditions. While this seems like a great idea at face value, the study found that children who had nurse visits were more likely to be sent to urgent care or the emergency department and more likely to be readmitted to the hospital. In the end, this type of service led children to receive more medical care than necessary, the study authors found.
The review also included evidence recommending against antibiotics to prevent urinary tract infections, probiotics for the stomach bug and intensive cardiac screening programs for athletes.
The take-home message: Identifying medical practices that don’t help and may harm children avoids unnecessary medical problems and also prevent unnecessary use of medical resources.
Visit Cornell University’s Bronfenbrenner Center for Translational Research’s website for more information on our work solving human problems.
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