As part of the ongoing Choosing Wisely campaign, the AAP released a new list of tests and procedures that should prompt careful discussion between parents and physicians. The new Choosing Wisely list supports evidence-based strategies to choose tests when appropriate and to avoid them when they are unlikely to benefit the child, or possibly cause harm. The "Five Things Physicians and Patients Should Question" list of tests to question includes:

1. Hormone tests for children with pubic hair and/or body odor but no other signs of puberty. The AAP advises against these tests when development of pubic or axillary hair and/or underarm odor aren't accompanied by other physical signs of sexual maturation such as breast development in girls, or rapid growth.
2. Screening tests to detect chronic disease or endocrine disorders in healthy children growing at or above the 3rd percentile with a normal growth rate. Even in children below the 3rd percentile for height with a normal history and physical exam, these tests only reveal new, underlying conditions about 1 percent of the time. In patients with significantly short stature or who are well below their genetic potential based on the height of their parents, the AAP advises tiered or sequential screening.
3. Routine vitamin D screening in otherwise healthy children, including those who are overweight or obese. Vitamin D deficiency screening is only advised for patients with disorders linked with low bone mass, such as rickets, or a history of repeated, low-trauma bone fractures. Vitamin D supplements are a cost-effective option for children with insufficient dietary intake or for obese children, who often have low vitamin D levels.
4. Thyroid function and/or insulin levels tests in children with obesity. Testing thyroid function in obese children should be considered only if the growth rate is below what it should be, or if there are other signs of a thyroid problem. Measuring insulin levels in obese children does not affect how doctors treat them.
5. Routine thyroid ultrasounds in children who have simple goiters or autoimmune thyroiditis. The AAP advises limiting this test to children who have significantly enlarged thyroid glands, swelling on just one side of the neck, or nodules that can be felt through the skin during a physical exam. Overuse of ultrasonography can cause needless anxiety for patients and parents, waste families' time and health care dollars.

"This new Choosing Wisely list will enhance discussions physicians and families have about issues in growth and development that often come up, and help craft the best treatment plans," Dr. Kaplowitz said.