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Daily Dose

When Tests Should Be Ordered

1:30 to read

The American Academy of Pediatrics has been involved in a series of articles entitled “Choosing Wisely”, as it relates to when and why some tests should be ordered. The latest is related to endocrinology and the myriad of laboratory tests that are often ordered unnecessarily and are overused.

 

The AAP states that it is important to, “avoid ordering Vitamin D concentrations routinely in otherwise healthy children, which includes children who are overweight or obese”.  While a Vitamin D level is the correct screening lab to monitor for Vitamin D deficiency, it should only be ordered in patients with disorders associated with low bone mass (like rickets), some children with liver disease, or in those children who have recurrent low-trauma fractures (not one broken arm).

 

I have seen many patients who have had lab work done by another physician in which they “have a low Vitamin D level” and they are concerned that this is the reason their child is “fatigued”, “depressed”, “not doing well in school”….just to name a few of the statements. Vitamin D levels have not been correlated with any of the above. 

 

Due to the variability of tests available, and unclear cutoffs for deficiency, many children could be misclassified as having Vitamin D deficiency.  The uncertainty around “ normal levels” may lead to over diagnosis, with no clear benefit and may cause undue anxiety. 

 

More important than a Vitamin D level is the assurance that parents are routinely offering their children milk and dairy products high in Vitamin D. Vitamin D is necessary to help the body use calcium, which is the building block for strong bones and teeth.  As many parents have stopped giving their children milk, but are offering more water, the daily recommended intake of Vitamin D and calcium may be difficult to reach.

 

Other foods high in Vitamin D include canned tuna, salmon and some fortified cereals.

 

If you have questions about Vitamin D intake talk to your pediatrician.  

 

 

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