When it comes to health care, especially for children, more isn’t always better

Dr. Elizabeth Wolf has championed efforts to shine a spotlight on and address concerns about negative impacts from common, and often unnecessary, medical interventions in pediatric care across the United States. This week, Dr. Wolf and four co-authors had an article published in Pediatrics, a journal of the American Academy of Pediatrics, addressing the latest research on pediatric overuse.

Although advancements in pediatric care, including vaccines, antibiotics and sophisticated imaging studies, have led to substantial improvements in children’s health, more recently there have been calls to reduce certain medical interventions.

What does the latest research tell us about low-value care in pediatrics?

“Low-value care is described as services that provide little or no benefit to patients and may even result in harm,” said Dr. Wolf. “We must continually reevaluate through targeted research which health care practices are low-value as disease prevalence changes, new evidence emerges, new technology is developed and cultural values shift.”

Children may be particularly vulnerable to some of the harms of low-value care, including radiation from unnecessary radiologic studies and alterations in the microbiome from overuse of antibiotics. In their latest efforts, Dr. Wolf and her colleagues reviewed 201 articles pertaining to pediatric medical overuse from 2021-2022. They scored each using an established rubric, identified the ten most impactful articles and conducted a thorough analysis. Their summary describes key elements uncovered in the literature identifying pediatric overuse, including:

• the importance of questioning established practices, such as routine temperature measurement at well-child visits
• treatment durations for pneumonia
• being judicious with common pediatric surgeries such as tonsillectomy, ear tube placement and gastrostomy tube placement
• the potential harms of proton pump inhibitors and over the counter cold remedies in children

“There are many factors that may lead to low-value care, such as clinical habits that have been established over time,” added Dr. Wolf. “It is important to regularly review current medical practices to determine which ones are beneficial and which ones may be harmful to children.”

Dr. Wolf and her co-authors are also members of the Academic Pediatric Association’s Health Care Value special interest group, with a mission to improve the value of health care in pediatrics through quality improvement and cost efficiency.

Learn more about the valuable research at CHoR that’s leading to better pediatric care.