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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.
Choosing Wisely Canada
Canadian Paediatric Society
When children with a sore throat present symptoms strongly suggestive of viral illness, such as a runny nose (rhinorrhea), cough or a hoarse voice, a throat swab is unlikely to change management, as these children seldom have ‘Strep Throat’ as the cause of their sore throat.
ver más ... 2016Don’t administer psychostimulant medications to preschool children with Attention Deficit Disorder (ADD), but offer parent-administered behavioural therapy.
Choosing Wisely Canada
Canadian Paediatric Society
The treatment of preschool-aged children with ADD should involve evidence-based behavioural therapy first, as it is more effective than psychostimulants in this age group. Preschool-aged children are more sensitive to all psychostimulant side effects, including those associated with growth velocity. Behavioural therapy requires more time and resources, but the benefits are more sustained with minimal adverse events.
ver más ... 2016Don’t perform screening panels (IgE tests) for food allergies without previous consideration of the pertinent medical history.
Choosing Wisely Canada
Canadian Paediatric Society
Allergy tests for food may be falsely positive when they are performed in children who don’t have a history suggesting a serious (IgE mediated) allergy to that food. These results can lead to avoidance of foods to which a true allergy has not been validly documented. When symptoms suggest a food allergy, a careful history should be completed before ordering specific tests, and these should be selected based on the history. A history that suggests serious allergy to a food may include: (1) ...
ver más ... 2016Don’t routinely use acid blockers or motility agents for the treatment of gastroesophageal reflux in infants.
Choosing Wisely Canada
Canadian Paediatric Society
Medications that decrease acidity in the stomach do not improve infants’ crying or spitting up. These symptoms are common and usually improve on their own, as the child grows up. Studies show that infants who take medications that block stomach acid secretion have more respiratory and gastrointestinal infections. Motility agents do not improve symptoms of reflux in infants but they can have side effects on the heart and nervous system, as well as dangerous interactions with other medications. ...
ver más ... 2016Don’t perform particle repositioning maneuvers (Epley or Semont) without a clinical diagnosis of posterior semicircular canal benign paroxysmal positional vertigo in the affected ear.
Choosing Wisely Canada
Canadian Society of Otolaryngology-Head & Neck Surgery
Posterior semicircular canal benign paroxysmal positional vertigo should be diagnosed and confirmed with a positive Dix-Hallpike test, and only then should a particle repositioning maneuver be performed. If a patient with positional vertigo has a Dix-Hallpike test that is repeatedly negative or results in atypical nystagmus, less common BPPV variants or central positional vertigo should be considered.
ver más ... 2016