Choosing Wisely

EAP Statement on Choosing Wisely

List of Recommendations in Paediatrics

Category / TitleOrganizationCountryLinkDate of publishingReferences
Gastroenterology
Don’t routinely use acid blockers or motility agents for the treatment of gastroesophageal reflux in infants. DetailsCW CanadaCanadahttps://choosingwiselycanada.org/paediatrics/Last updated November 30, 2016References
Avoid using acid blockers and motility agents such as metoclopramide (generic) for physiologic gastroesophageal reflux (GER) that is effortless, painless, and not affecting growth. Do not use medication in the so-called “happy-spitter.”AAP USAhttp://www.choosingwisely.org/societies/american-academy-of-pediatrics/March 17, 2014 References
Do not routinely treat gastroesophageal reflux disease (GORD) in infants with acid suppression therapyRACP Paediatrics & Child Health DivisionAustraliahttp://www.choosingwisely.org.au/recommendations/paediatrics-and-child-health-division-(racp)Last Reviewed September 15, 2017References
Do not prescribe medicines for a physiologic gastro esophageal reflux.Israel
Avoid routine use of anti-reflux medications for treatment of symptomatic gastroesophageal reflux disease (GERD) or for treatment of apnea and desaturation in preterm infants.American Academy of Pediatrics – Section on Perinatal PediatricsUSAhttp://www.choosingwisely.org/societies/american-academy-of-pediatrics/July 20, 2015References
Avoid using drugs (anti H2, procynetics, protonic pump inibitors-PPI) in physiological Gastro Esophageal Reflux (GER) not interfering with growth and not associated with clinical signs or symptoms of GER Disease. Don’t prescribe drugs in “happy spitters”.Associazione Culturale Pediatri (ACP)Italyhttps://www.choosingwiselyitaly.org/PDF/ENGracc/Scheda%20ACP%20english.pdfFebruary 2015References
Do not treat gastroesophageal reflux in infants routinely with acid suppression therapy.Society of Hospital MedicineUSAJournal of Hospital Medicine. 2013;8(9):479­485. 2013
Do not use pH monitoring and antacids <1year ageNoewegian paediatric societyNorway43344
Do not routinely order abdominal X-rays for the diagnosis of non-specific abdominal pain in childrenRACP Paediatrics & Child Health DivisionAustraliahttp://www.choosingwisely.org.au/recommendations/paediatrics-and-child-health-division-(racp)Last Reviewed September 15, 2017References
Avoid overviews of abdomen in children with abdominal pain.Noewegian paediatric societyNorwayJanuary 2019References
Polyethylene Glycol should be used in preference to Lactulose in the treatment of chronic constipation in children. RCPCHUKhttp://www.choosingwisely.co.uk/i-am-a-clinician/recommendations/#1476655897805-9c3066de-7f8308/05/1900References
Do not use serologic test for the diagnosis of celiac disease in children, until the gluten has been introduced in the diet.Spanish Association of Pediatrics Spainhttp://10.15.5.20:8162/organizacion/sns/planCalidadSNS/cal_sscc.htmDec 2013
Infectiology
Don’t routinely do a throat swab when children present with a sore throat if they have a cough, rhinitis, or hoarseness as they almost certainly have viral pharyngitis.CW CanadaCanadahttps://choosingwiselycanada.org/paediatrics/Last updated November 30, 2016References
do not throat swabs in children below 3 years of age.Israel
Don’t recommend the use of cough and cold remedies in children under six years of age.CW Canada Canadahttps://choosingwiselycanada.org/paediatrics/Last updated November 30, 2016References
Cough and cold medicines should not be prescribed, recommended or used for respiratory illnesses in young children.AAP USAhttp://www.choosingwisely.org/societies/american-academy-of-pediatrics/released 2013, last updated June 12, 2018References
Avoid coughing or expectorant medications for children with cough or shortness of breath.Norwegian Society of paediatricsNorwayJanuary 2019References
do not prescribe cough suppressants in children below 3 years of age.Israel
Antibiotics should not be used for viral respiratory illnesses (sinusitis, pharyngitis, bronchitis and bronchiolitis).AAP USAhttp://www.choosingwisely.org/societies/american-academy-of-pediatrics/released 2013, last updated June 12, 2018References
Don’t administer antibiotics in children with acute pharyngitis unless microbiologic confirmation of streptococcal infection has been carried out.Italian Society for Preventive and Social Pediatrics (SIPPS)Italyhttps://www.choosingwiselyitaly.org/images/ENGLISH/PDF/Scheda-SIPPS_en.pdfMarch 2017References
Do not routinely prescribe oral antibiotics to children with fever without an identified bacterial infectionRACP Paediatrics & Child Health DivisionAustraliahttp://www.choosingwisely.org.au/recommendations/paediatrics-and-child-health-division-(racp)Last Reviewed September 15, 2017References
Don’t prescribe antibiotics to treat respiratory infections probably due to viral agents in children (pharyngitis, sinusitis, bronchitis). associazione Culturale Pediatri (ACP)Italyhttps://www.choosingwiselyitaly.org/PDF/ENGracc/Scheda%20ACP%20english.pdfFebruary 2015References
Do not treat URTI with antibioticsIsrael
Avoid the use of surveillance cultures for the screening and treatment of asymptomatic bacteriuria.AAP USAhttp://www.choosingwisely.org/societies/american-academy-of-pediatrics/March 17, 2014 updated July, 2016References
Avoid ordering follow-up urine cultures after treatment for an uncomplicated urinary tract infection (UTI) in patients that show evidence of clinical resolution of infection.American Academy of Pediatrics – Section on Nephrology and the American Society of Pediatric NephrologyUSAhttp://www.choosingwisely.org/topic-area/pediatrics/July 16, 2018references
Don’t perform voiding cystourethrogram (VCUG) routinely in first febrile urinary tract infection (UTI) in children aged 2 -24 months.American Academy of Family PhysiciansUSAhttp://www.choosingwisely.org/topic-area/pediatrics/September 24, 2013References
Do not diagnose Urinary Tract Infection based on urine cultures alone.Federazione Italiana medici pediatriItalyhttps://www.choosingwiselyitaly.org/images/ITALIANO/Pdf/Scheda-FIMP.pdfOctober 2018References
Avoid routine continuation of antibiotic therapy beyond 48 hours for initially asymptomatic infants without evidence of bacterial infection.American Academy of Pediatrics – Section on Perinatal PediatricsUSAhttp://www.choosingwisely.org/societies/american-academy-of-pediatrics/July 20, 2015References
Do not routinely use Antibiotics in newborns >36-48 hours when bacterial infection is unlikelyNoewegian paediatric societyNorwayhttps://beta.legeforeningen.no/kloke-valg/1.09.2018
Do not routinely undertake chest X rays for the diagnosis of bronchiolitis in children or routinely prescribe salbutamol or systemic corticosteroids to treat bronchiolitis in childrenRACP Paediatrics & Child Health DivisionAustraliahttp://www.choosingwisely.org.au/recommendations/paediatrics-and-child-health-division-(racp)Last Reviewed September 15, 2017References
Do not use salmeterol in children with acute asthmasocietà Italiana per le Malattie Respiratorie Infantili (SIMRI)Italyhttps://www.choosingwiselyitaly.org/PDF/ITAracc/Scheda%20SIMRI.pdfMarch 2017References
Do not use inhaled corticosteroids in children’s respiratory tract inflamatory diseases
Associazione Culturale Pediatri (ACP)Italyhttps://www.choosingwiselyitaly.org/PDF/ENGracc/Scheda%20ACP%20english.pdfFebruary 2015References
Do not use bronchodilators in children with bronchiolitis.Society of Hospital MedicineUSAJournal of Hospital Medicine. 2013;8(9):479­485. 0.0.2013
Bronchodilators should not be used in the treatment of mild or moderate presentations of acute bronchiolitis in children without any underlying conditions.RCPCHUKhttp://www.choosingwisely.co.uk/i-am-a-clinician/recommendations/#1476655897805-9c3066de-7f830.0.2016References
Do not routinely do repeated blood samples, chest x-ray and oxygen monitoring in bronchiolitisNorwegian Society of paediatricsNorway43344
Do not prescribe any drug (nebulized and/or by systemic route) for treatment of BronchiolitisFederazione Italiana medici pediatriItalyhttps://www.fimp.pro/news/news-1/388-dalla-fimp-le-regole-sulle-pratiche-a-rischio-d%E2%80%99inappropriatezzaOctober 2018See references on
https://www.choosingwiselyitaly.org/images/ITALIANO/Pdf/Scheda-FIMP.pdf
Avoid routine inhalation therapy for bronchiolitisNorwegian Society of paediatricsNorwayJanuary 2019
Do not recommended the routine use of chest radiography in bronchiolitisSpanish Association of Pediatrics Spainhttp://10.15.5.20:8162/organizacion/sns/planCalidadSNS/cal_sscc.htmDec 2013
Don’t prescribe Chest Radiography to confirm diagnosis and to follow up in a not complicated pneumonia in children.Associazione Culturale Pediatri (ACP)Italyhttps://www.partecipasalute.it/cms/files/Associazione%20Culturale%20Pediatri%20ACP_0.pdfFebruary 2015References
Don’t treat otitis media (middle ear infection) with antibiotics, in non-Indigenous children aged 2-12years, where reassessment is a reasonable optionThe Royal Australian College of General PractitionersAustraliahttp://www.choosingwisely.org.au/recommendations/racgpMarch, 2016References
Avoid routine antibiotic treatment for acute ear infection in children over 1 year of age.Norwegian Society of paediatricsNorwayhttps://beta.legeforeningen.no/kloke-valg/January 2019References
When possible, do not give immediate antibiotic therapy in acute otitis mediaIsrael
Do not routinely use Systemic steroids in airway infections (except moderate/severe pseudocroup)Norwegian Society of paediatricsNorwayhttps://beta.legeforeningen.no/kloke-valg/1.09.2018
Do not use systemic corticosteroids in children under 2 years of age with a lower respiratory tract infectionSociety of Hospital MedicineUSAJournal of Hospital Medicine. 2013;8(9):479­485. 0.0.2013
Do not treat a fever systemically unless there are symptoms of discomfort. If you decide to treat it, use an appropriate dose avoiding combined/alternate use of paracetamol and ibuprofen.Federazione Italiana medici pediatriItalyhttps://www.choosingwiselyitaly.org/images/ENGLISH/PDF/Scheda-FIMP_en.pdfoctober 2018
Do not use corticosteroids for fevermanagmentfederazione Italiana medici pediatriitalyhttps://www.fimp.pro/news/news-1/388-dalla-fimp-le-regole-sulle-pratiche-a-rischio-d%E2%80%99inappropriatezzaoctober 2018
Do not to delay the empirical antibiotic therapy at the suspicion of invasive meningococcal disease by the fact of obtaining crops (blood and/or cerebrospinal fluid). Spanish Association of Pediatrics Spainhttp://10.15.5.20:8162/organizacion/sns/planCalidadSNS/cal_sscc.htmDec 2013
. Do not give antibiotics routinely to children with gastroenteritisSpanish Association of Pediatrics Spainhttp://10.15.5.20:8162/organizacion/sns/planCalidadSNS/cal_sscc.htmDec 2013
Do not routinely use antibiotics in acute gastroenteritis .Israel
Don’t prescribe blood exams in children with acute pharyngitis.Italian Society for Preventive and Social Pediatrics (SIPPS)Italyhttps://www.choosingwiselyitaly.org/images/ENGLISH/PDF/Scheda-SIPPS_en.pdfMarch 2017References
If throat culture is performed, susceptibility tests on isolates should not be executed in children with acute pharyngitis.Italian Society for Preventive and Social Pediatrics (SIPPS)Italyhttps://www.choosingwiselyitaly.org/images/ENGLISH/PDF/Scheda-SIPPS_en.pdfMarch 2017References
Don’t shorten antibiotic course in children with acute pharyngitis and microbiologic confirmation of streptococcal infection.Italian Society for Preventive and Social Pediatrics (SIPPS)Italyhttps://www.choosingwiselyitaly.org/images/ENGLISH/PDF/Scheda-SIPPS_en.pdfMarch 2017References
1. Avoid taking urine samples from children> 2 months with symptoms and signs of respiratory infection, unless the child is septic, predisposed to urinary tract infection or has specific urinary tract symptoms.Norwegian Society of paediatricsNorwayhttps://beta.legeforeningen.no/kloke-valg/January 2019
Don’t administer steroids to children with acute pharyngitis.Italian Society for Preventive and Social Pediatrics (SIPPS)Italyhttps://www.choosingwiselyitaly.org/images/ENGLISH/PDF/Scheda-SIPPS_en.pdfMarch 2017References
Trauma/Emergency
Computed tomography (CT) scans are not necessary in the immediate evaluation of minor head injuries; clinical observation/Pediatric Emergency Care Applied Research Network (PECARN) criteria should be used to determine whether imaging is indicated.AAP USAhttp://www.choosingwisely.org/societies/american-academy-of-pediatrics/released 2013, last updated July, 2016References
Don’t routinely obtain CT scanning of children with mild head injuries.American Association of Neurological Surgeons and Congress of Neurological SurgeonsUSAhttp://www.choosingwisely.org/topic-area/pediatrics/June 24, 2014References
Don’t routinely repeat labs hemoglobin and hematocrit in the hemodynamically normal pediatric patients with isolated blunt solid organ injury.American Academy of NursingUSAhttp://www.choosingwisely.org/topic-area/pediatrics/April 19, 2018References
Avoid instituting intravenous (IV) fluids before doing a trial of oral rehydration therapy in uncomplicated emergency department cases of mild to moderate dehydration in children.American College of Emergency PhysiciansUSAhttp://www.choosingwisely.org/topic-area/pediatrics/October 14, 2013References
Nephrology
Do not initiate an outpatient hypertension (HTN) work-up in asymptomatic pediatric patients prior to repeating the blood pressure measurement.American Academy of Pediatrics – Section on Nephrology and the American Society of Pediatric NephrologyUSAhttp://www.choosingwisely.org/topic-area/pediatrics/July 16, 2018References
Do not place central lines or peripherally inserted central lines (PICC) in pediatric patients with advanced (Stage 3-5) chronic kidney disease (CKD)/end-stage renal disease (ESRD) without consultation with pediatric nephrology due to goals to avoid adverse events, preserve long-term vascular access, and avoid unnecessary and costly procedures.American Academy of Pediatrics – Section on Nephrology and the American Society of Pediatric NephrologyUSAhttp://www.choosingwisely.org/societies/american-academy-of-pediatrics/July 16, 2018References
Do not initiate a work up for hematuria or proteinuria before repeating an abnormal urine dipstick analysis (UA).American Academy of Pediatrics – Section on Nephrology and the American Society of Pediatric NephrologyUSAhttp://www.choosingwisely.org/societies/american-academy-of-pediatrics/July 16, 2018References
Don’t order routine screening urine analyses (UA) in healthy, asymptomatic pediatric patients as part of routine well child care.American Academy of Pediatrics – Section on Nephrology and the American Society of Pediatric NephrologyUSAhttp://www.choosingwisely.org/societies/american-academy-of-pediatrics/July 16, 2018References
Orthopedics
Do not order a screening hip ultrasound to rule out developmental hip dysplasia or developmental hip dislocation if the baby has no risk factors and has a clinically stable hip examination.American Academy of Pediatrics – Section on Orthopaedics and the Pediatric Orthopaedic Society of North AmericaUSAhttp://www.choosingwisely.org/societies/american-academy-of-pediatrics/February 12, 2018References
Do not order radiographs or advise bracing or surgery for a child less than 8 years of age with simple in-toeing gaitAmerican Academy of Pediatrics – Section on Orthopaedics and the Pediatric Orthopaedic Society of North AmericaUSAhttp://www.choosingwisely.org/societies/american-academy-of-pediatrics/February 12, 2018References
Do not order custom orthotics or shoe inserts for a child with minimally symptomatic or asymptomatic flat feet.American Academy of Pediatrics – Section on Orthopaedics and the Pediatric Orthopaedic Society of North AmericaUSAhttp://www.choosingwisely.org/societies/american-academy-of-pediatrics/february 12, 2018references
Do not order advanced imaging studies (MRI or CT) for most musculoskeletal conditions in a child until all appropriate clinical, laboratory and plain radiographic examinations have been completed.American Academy of Pediatrics – Section on Orthopaedics and the Pediatric Orthopaedic Society of North AmericaUSAhttp://www.choosingwisely.org/societies/american-academy-of-pediatrics/February 12, 2018References
Do not order follow-up X-rays for buckle (or torus) fractures if they are no longer tender or painful.American Academy of Pediatrics – Section on Orthopaedics and the Pediatric Orthopaedic Society of North AmericaUSAhttp://www.choosingwisely.org/societies/american-academy-of-pediatrics/February 12, 2018References
Helmet therapy is not effective in the treatment of positional plagiocephaly in children, other treatment options should be considered and discussed with your patient.RCPCHUKhttp://www.choosingwisely.co.uk/i-am-a-clinician/recommendations/#1476655897805-9c3066de-7f830.0.2016
Endocrinology
Avoid ordering LH and FSH and either estradiol or testosterone for children with pubic hair and/or body odor but no other signs of puberty.American Academy of Pediatrics – Section on EndocrinologyUSAhttp://www.choosingwisely.org/societies/american-academy-of-pediatrics/October 2, 2017References
Avoid routinely measuring thyroid function and/or insulin levels in children with obesity.American Academy of Pediatrics – Section on EndocrinologyUSAhttp://www.choosingwisely.org/societies/american-academy-of-pediatrics/October 2, 2017References
Avoid routinely ordering thyroid ultrasounds in children who have simple goiters or autoimmune thyroiditis.American Academy of Pediatrics – Section on EndocrinologyUSAhttp://www.choosingwisely.org/societies/american-academy-of-pediatrics/October 2, 2017References
Avoid ordering Vitamin D concentrations routinely in otherwise healthy children, including children who are overweight or obese.American Academy of Pediatrics – Section on EndocrinologyUSAhttp://www.choosingwisely.org/societies/american-academy-of-pediatrics/October 2, 2017References
Avoid ordering screening tests looking for chronic illness or an endocrine cause, including CBC, CMP, IGF-1, thyroid tests, and celiac antibodies, in healthy children who are growing at or above the 3rd percentile for height with a normal growth rate (i.e., not crossing percentiles) and with appropriate weight gain.American Academy of Pediatrics – Section on EndocrinologyUSAhttp://www.choosingwisely.org/societies/american-academy-of-pediatrics/October 2, 2017References
Neonatology
Avoid routine screening term-equivalent or discharge brain MRIs in preterm infants.American Academy of Pediatrics – Section on Perinatal PediatricsUSAhttp://www.choosingwisely.org/societies/american-academy-of-pediatrics/July 20, 2015References
Avoid routine daily chest radiographs without an indication for intubated infants.American Academy of Pediatrics – Section on Perinatal PediatricsUSAhttp://www.choosingwisely.org/societies/american-academy-of-pediatrics/July 20, 2015References
Avoid routine use of pneumograms for pre-discharge assessment of ongoing and/or prolonged apnea of prematurity.American Academy of Pediatrics – Section on Perinatal PediatricsUSAhttp://www.choosingwisely.org/societies/american-academy-of-pediatrics/July 20, 2015References
Don’t prescribe high-dose dexamthasone (0.5 mg/kg per day) for the prevention or treatment of bronchopulmonary dysplasia in pre-term infants.AAP USAhttp://www.choosingwisely.org/societies/american-academy-of-pediatrics/March 17, 2014 References
Avoid formula supplement in the first days of life for healthy, full term, breast- fed newborns without proved
medical contraindications.
associazione Culturale Pediatri (ACP)Italyhttps://www.partecipasalute.it/cms/files/Associazione%20Culturale%20Pediatri%20ACP_0.pdfFebruary 2015References
Rheumatology
Don’t repeat a confirmed positive ANA in patients with established JIA or systemic lupus erythematosus (SLE).American College of Rheumatology – Pediatric RheumatologyUSAhttp://www.choosingwisely.org/topic-area/pediatrics/October 27, 2013References
Don’t perform methotrexate toxicity labs more often than every 12 weeks on stable doses.American College of Rheumatology – Pediatric RheumatologyUSAhttp://www.choosingwisely.org/topic-area/pediatrics/october 27, 2013references
Don’t routinely perform surveillance joint radiographs to monitor juvenile idiopathic arthritis (JIA) disease activity.American College of Rheumatology – Pediatric RheumatologyUSAhttp://www.choosingwisely.org/topic-area/pediatrics/October 27, 2013References
Don’t test for Lyme disease as a cause of musculoskeletal symptoms without an exposure history and appropriate exam findings.American College of Rheumatology – Pediatric RheumatologyUSAhttp://www.choosingwisely.org/topic-area/pediatrics/October 27, 2013References
Don’t order autoantibody panels unless positive antinuclear antibodies (ANA) and evidence of rheumatic disease.American College of Rheumatology – Pediatric RheumatologyUSAhttp://www.choosingwisely.org/topic-area/pediatrics/October 27, 2013References
Ophthalmology
Don’t order retinal imaging tests for children without symptoms or signs of eye disease.American Association for Pediatric Ophthalmology and StrabismusUSAhttp://www.choosingwisely.org/topic-area/pediatrics/October 8, 2013References
Don’t routinely order imaging for all patients with double vision.American Association for Pediatric Ophthalmology and StrabismusUSAhttp://www.choosingwisely.org/topic-area/pediatrics/October 8, 2013References
Don’t recommend vision therapy for patients with dyslexia.American Association for Pediatric Ophthalmology and StrabismusUSAhttp://www.choosingwisely.org/topic-area/pediatrics/October 8, 2013References
Annual comprehensive eye exams are unnecessary for children who pass routine vision screening assessmentsAmerican Association for Pediatric Ophthalmology and StrabismusUSAhttp://www.choosingwisely.org/topic-area/pediatrics/October 8, 2013References
Don’t put asymptomatic children in weak reading glasses.American Association for Pediatric Ophthalmology and StrabismusUSAhttp://www.choosingwisely.org/topic-area/pediatrics/October 8, 2013References
Allergology
Don’t perform screening panels (IgE tests) for food allergies without previous consideration of the pertinent medical history.CW CanadaCanadahttps://choosingwiselycanada.org/paediatrics/Last updated November 30, 2016References
Don’t perform screening panels for food allergies without previous consideration of medical history.AAP USAhttp://www.choosingwisely.org/societies/american-academy-of-pediatrics/March 17, 2014 References
Do not routinely use test with IgE panels for food allergyNoewegian paediatric societyNorwayhttps://beta.legeforeningen.no/kloke-valg/1.09.2018
Pulmology
Do not routinely order chest X-rays for the diagnosis of asthma in childrenRACP Paediatrics & Child Health DivisionAustraliahttp://www.choosingwisely.org.au/recommendations/paediatrics-and-child-health-division-(racp)Last Reviewed September 15, 2017References
do not perform an x ray as a routine in a child  that presents in the ER with an acute asthmatic attackIsrael
Do not perform chest X-ray in a child with suspected non-severe community-acquired pneumonia or with uncomplicated acute asthma.Società Italiana per le Malattie Respiratorie Infantili (SIMRI)Italyhttps://www.choosingwiselyitaly.org/images/ENGLISH/PDF/Scheda-SIMRI_en.pdfMarch 2017References
Do not order chest radiographs in children with asthma or bronchiolitis.Society of Hospital MedicineUSAJournal of Hospital Medicine. 2013;8(9):479­485. 2013
Do not prescribe antihistamines for preventing asthma in children.Italian Society for Pediatric Respiratory Diseases (SIMRI)Italyhttps://www.choosingwiselyitaly.org/images/ENGLISH/PDF/Scheda-SIMRI_en.pdfMarch 2017References
Asthma should not be diagnosed without performing spirometryItalian Society for Pediatric Respiratory Diseases (SIMRI)Italyhttps://www.choosingwiselyitaly.org/images/ENGLISH/PDF/Scheda-SIMRI_en.pdfMarch 2017References
Investigations
Do not do a Chest X ray without a clear clinical suspicionSocietà Italiana per le Malattie Respiratorie Infantili (SIMRI)Italyhttps://www.choosingwiselyitaly.org/PDF/ITAracc/Scheda%20SIMRI.pdfMarch 2017References
Infant home apnea monitors should not be routinely used to prevent sudden death syndrome (SIDS).AAP USAhttp://www.choosingwisely.org/societies/american-academy-of-pediatrics/March 17, 2014 updated June 12, 2018References
Neuroimaging (CT, MRI) is not necessary in a child with simple febrile seizure.AAP USAhttp://www.choosingwisely.org/societies/american-academy-of-pediatrics/References
It is not recommended to perform imaging studies in a simple febrile convulsions.Israel
Do not perform, routinely, electroencephalogram or studies of neuroimaging (CT, MRI), in children with simple febrile convulsion.Spanish Association of Pediatrics Spainhttp://10.15.5.20:8162/organizacion/sns/planCalidadSNS/cal_sscc.htm Dec 2013
Don’t routinely order an EEG on neurologically healthy children who have a simple febrile seizure.American Academy of NursingUSAhttp://www.choosingwisely.org/topic-area/pediatrics/March 21, 2017References
Don’t apply continuous cardiac-respiratory or pulse oximetry monitoring to children and adolescents admitted to the hospital unless condition warrants continuous monitoring based on objectively scored cardiovascular, respiratory, and behavior parameters.American Academy of NursingUSAhttp://www.choosingwisely.org/topic-area/pediatrics/April 19, 2018References
Do not use continuous pulse oximetry routinely in children with acute respiratory illness unless they are on supplemental oxygen. Society of Hospital MedicineUSAJournal of Hospital Medicine. 2013;8(9):479­485. 0.0.2013
It is not recommended to check vitamin D levels in healthy children.Israel
Do not repeat hemoglobin electrophoresis (or equivalent) in patients who have a prior result and who do not require therapeutic intervention or monitoring of hemoglobin variant levels.

American Society for Clinical PathologyUSAhttp://www.choosingwisely.org/societies/american-academy-of-pediatrics/October 19, 2017References
Neurology
Buccal midazolam or lorazepam should be in the treatment of prolonged seizures in young people and children, as these are the most effective treatments, in preference to rectal and intravenous diazepam.RCPCHUKhttp://www.choosingwisely.co.uk/i-am-a-clinician/recommendations/#1476655897805-9c3066de-7f830.0.2016References
Don’t routinely order a head CT to assess for shunt failure in children with hydrocephalus.American Academy of NursingUSAhttp://www.choosingwisely.org/topic-area/pediatrics/March 21, 2017References
Do not use topic nasal therapy by micronized nasal douche using drugs not specifically authorized for this type of treatment federazione Italiana medici pediatriItalyhttps://www.fimp.pro/news/news-1/388-dalla-fimp-le-regole-sulle-pratiche-a-rischio-d%E2%80%99inappropriatezza1.10.2018
Avoid routine testing for antiepileptic drug (AED) levels in people with epilepsy.American Epileply SocietyUSAhttp://www.choosingwisely.org/topic-area/pediatrics/15.08.2018References
Don’t administer psychostimulant medications to preschool children with Attention Deficit Disorder (ADD), but offer parent-administered behavioural therapy.CW CanadaCanadahttps://choosingwiselycanada.org/paediatrics/Last updated November 30, 2016References

Useful Resources and Links

  1. National pediatric websites: Choosing Wisely (clickable links for the websites)
    1. American Academy of Pediatrics: http://www.choosingwisely.org/societies/american-academy-of-pediatrics/
    2. Choosing Wisely Canada: https://choosingwiselycanada.org/paediatrics/
    3. Australia: http://www.choosingwisely.org.au/recommendations/paediatrics-and-child-health-division-(racp)
    4. Israel
    5. United Kingdom: https://www.choosingwisely.co.uk/i-am-a-clinician/recommendations/#1476655897805-9c3066de-7f83
    6. Italy: https://www.fimp.pro/news/news-1/388-dalla-fimp-le-regole-sulle-pratiche-a-rischio-d%E2%80%99inappropriatezza
    7. Norway: https://beta.legeforeningen.no/kloke-valg/
  2. Pictures for presentations:
    1. Canada digital toolkit:
      https://choosingwiselycanada.org/wp-content/uploads/2017/05/More-is-Not-Always-Better-Digital-Toolkit.pdf
    2. Canada Choosing Wisely posters:
      https://choosingwiselycanada.org/wp-content/uploads/2017/05/11×17-Hotdog-EN.pdf
      https://choosingwiselycanada.org/wp-content/uploads/2017/05/11×17-Washing-machine-EN.pdf
      https://choosingwiselycanada.org/wp-content/uploads/2017/05/11×17-Weightlifter-EN.pdf
      https://choosingwiselycanada.org/wp-content/uploads/2017/05/11×17-Luggage.pdf
  1. Animations and videos
    1. Canada Choosing Wisely Washing Machine: https://vimeo.com/135971467
    2. Canada “Happy” song: https://www.youtube.com/watch?v=FqQ-JuRDkl8
    3. Norway Milk Glass: https://www.facebook.com/klokevalg/videos/448665165544239/
    4. Animation dr Google – rash: https://www.facebook.com/klokevalg/videos/289911761823415/
    5. Animation dr Google – influenza:
      https://www.facebook.com/klokevalg/videos/1090192854516530/
  1. Suggested reading 1-22
  1. Ahn HS, Welch HG. South Korea’s Thyroid-Cancer “Epidemic”–Turning the Tide. N Engl J Med. 2015;373:2389-90.
  2. Born KB, Levinson W. Choosing Wisely campaigns globally: A shared approach to tackling the problem of overuse in healthcare. J Gen Fam Med. 2019;20:9-12.
  3. Bressan S, Romanato S, Mion T, Zanconato S, Da Dalt L. Implementation of adapted PECARN decision rule for children with minor head injury in the pediatric emergency department. Acad Emerg Med. 2012;19:801-7.
  4. Brodersen J, Kramer BS, Macdonald H, Schwartz LM, Woloshin S. Focusing on overdiagnosis as a driver of too much medicine. BMJ. 2018;362:k3494.
  5. Cassel CK, Guest JA. Choosing wisely: helping physicians and patients make smart decisions about their care. JAMA. 2012;307:1801-2.
  6. Davies I, Burman-Roy S, Murphy MS, Guideline Development G. Gastro-oesophageal reflux disease in children: NICE guidance. BMJ. 2015;350:g7703.
  7. Gadomski AM, Scribani MB. Bronchodilators for bronchiolitis. Cochrane Database Syst Rev. 2014:CD001266.
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