The American Academy of Pediatrics (AAP), as part of the Choosing Wisely campaign, recently released a list of medical therapies and practices for treating sleep disorders and asthma that should be considered carefully before being used with children.

Unnecessary treatments or testing often generate false positive findings that can lead to more testing, expense, inconvenience for patient and family, and even to painful invasive diagnostic or therapeutic procedures. The AAP Section on Pediatric Pulmonology and Sleep Medicine recognizes there are unique considerations and options as it concerns children.

“The family should always have a conversation with their physician with the understanding that, what works for an adult may not be appropriate for a child,” says Susan Millard, MD, FAAP, co-author of the Choosing Wisely list, in a release. “We know, for instance, that it’s important to be sure children are correctly using their inhalers and receiving the right dose of asthma medication for their age before changing a prescription.”

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The Choosing Wisely recommendations include:

  • Do not interpret pediatric sleep studies using adult standards. Sleep laboratories must have experience with children to perform an adequate test, and inclusion of caregivers in a child-friendly environment is vital.
  • Avoid stepping up asthma therapy by adding new drugs or increasing doses of medication before making sure the child is adhering to the present recommended treatment. The physician should review with the family how they are administering asthma medications and find out the refill history from the pharmacy, to confirm if the patient is using the therapy with the correct technique and frequency.
  • For intermittent or mild persistent asthma, avoid using long acting beta agonist (LABA) medications, which are supplied in combination with an inhaled steroid medication to help with opening the airways over a 12- to 24-hour period. This treatment should be reserved for those with moderate or severe persistent asthma. Avoid holding a mask away from a child’s face; this “blow-by method” lowers the amount of medication that reaches the child. Instead, a well-fitting properly placed mask is appropriate for younger children who are not crying. In an older, cooperative child, a t-piece with a mouthpiece should be used.
  • Avoid routinely using airway clearance therapy like chest percussion in previously healthy children with acute bronchiolitis, pneumonia, or an exacerbation of asthma.

“It’s important for parents to share any concerns they have regarding their child, and what is working and what is not working,” says Julie Katkin, MD, FAAP, co-author of the guidance, in a release. “If a medication does not appear to be working, the physician can help problem-solve and figure out a solution, based on information available.”

Choosing Wisely is an initiative of the ABIM Foundation, which seeks to promote conversations between clinicians and patients in choosing care that is supported by evidence; does not duplicate other tests or procedures already received; is free from harm; and truly necessary.

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