From Vincent Iannelli, M.D.,
Your Guide to Pediatrics.
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About.com Health's Disease and Condition content is reviewed by Kate Grossman, MD

Of course, most parents know about the more well known risks to their children's health and safety, such as the dangers of being exposed to second hand smoke, the need for car and booster seats to prevent injuries from car accidents, and using sun screen to prevent sun burn, etc.

Unfortunately, as other dangers become less common, less attention is paid to them.

For example, tuberculosis and lead poisoning are less common in children today than they have been in the past. This has resulted in the American Academy of Pediatrics moving away from recommending Universal Testing, in which all children are actually tested for tuberculosis and lead poisoning, and instead, recommending Universal Screening, in which all children are screened, such as by giving their parents a questionnaire with risk factors, and only tested if they have specific risk factors.

Universal screening ensures that low risk children aren't tested unnecessarily, and that those children that are at risk are found and treated.

This system only works if all children are screened though. If you live in an area where there is a low incidence of tuberculosis and/or lead poisoning, then your Pediatrician's office may be using its time and resources to look for more common conditions. To make sure that your child is tested if he is high risk, it is important to review the risk factors yourself and ask for testing if it is needed and hasn't already been done.

Screening is also used to detect children and adolescents who require testing for an elevated cholesterol and sexually transmitted diseases.

Tuberculosis Risk Factors

Risk factors for tuberculosis include:

• being exposed to someone who has, or is suspected to have, infectious tuberculosis
• contact with someone who has been in prison, the homeless, someone infected with HIV, drug users, migrant farm workers, or residents of a nursing home
• travel to countries with a high rate of tuberculosis, including Mexico, India, Vietnam, China, Philippines, and many countries in Latin America, Asia, the Middle East and Africa.
• adopted children from any high risk area should also be tested, including Romania and Russia.

If your child has any of these risk factors and hasn't been recently tested for tuberculosis, discuss it with your Pediatrician so that he can be tested.

Testing for tuberculosis is by the tuberculin skin test, which is usually a Mantoux test with 5 units of purified protein derivative (PPD). Other forms of testing are not recommended. After being placed on a child's forearm, the tuberculin skin test should be read 48-72 hours later by experienced personal. Interpretation depends not only on the type of reaction after the test, but also the child's risk of having tuberculosis. A child over 4 years of age with no risk factors may have a small reaction (5-14mm of induration) and not have a tuberculosis infection, while a child who has had close contact with someone with tuberculosis will be considered infected even with a very small reaction (greater than or equal to 5mm induration). Even children who have received the BCG vaccine can have skin testing done.