Obesity Screening
Although Pediatricians have long followed a child's growth on their growth chart, the increased use of body mass index charts makes it easy for your doctor to screen all children for obesity at well child visits. The AAP does now recommend that children start to have their BMI calculated beginning at age two.Cholesterol Screening
Children should have their cholesterol tested if they are considered to be high risk, including having a parent with an elevated blood cholesterol level of 240mg/dl or higher. Overweight children and adolescents who smoke are also considered high risk and should be considered for testing.Children with an acceptable total cholesterol of less than 170 mg/dl should have a repeat test within 5 years. Borderline levels (170-199 mg/dl) should be repeated and the two results averaged together. If the average value is greater than 170 mg/dl or if the initial test was greater than 200 mg/dl, then a 12 hour fasting lipoprotein analysis should be done, which includes triglyceride, HDL and total cholesterol levels. LDL levels can be estimated by subtracting the HDL from the total cholesterol.
Testing should also be done for children who have a parent or grandparent that, before age 55, had coronary atherolsclerosis or a myocardial infarction (heart attact), angina pectoris, peripheral vascular disease, cerebrovascular disease (stroke), or sudden cardiac death. Instead of a total cholesterol, in this situation, children should have a 12 hour fasting lipoprotein analysis.
Because the results of lipoprotein analysis can be very variable, all children should have the lipoprotein analysis repeated and the results averaged together. Children with an acceptable LDL cholesterol of less than 110mg/dl should have the test repeated within 5 years. If the average LDL cholesterol is boderline, between 110 and 129 mg/dl, steps should be taken to reduce other risk factors for coronary heart disease (smoking, being overweight, inactivity, high blood pressure), the child should follow a healthy eating plan, see a Registered Dietician for more help, and have the tests repeated in a year. High LDL cholesterol levels, greater than or equal to 130 mg/dl, require further evaluation, including testing other family members, evaluating for secondary causes of high cholesterol and familial disorders and an intensive clinical intervention should be started, which might include drug therapy if diet therapy fails.
STD Screening
The American Academy of Pediatrics also recommends that 'all sexually active patients should be screened for sexually transmitted diseases (STDs),' and that 'all sexually active females should have a pelvic examination. A pelvic examination and routine pap smear should be offered as part of preventive health maintenance between the ages of 18 and 21 years.'Screening is important because many STDs do not produce symptoms, but are still contagious.
Keep in mind that many Pediatricians can now do simple urine tests to screen for many STDs, including chlamydia and gonorrhea, by doing a PCR test, which is much less invasive than the old way of doing the test.
