Children’s Excessive Check-up Might Not Do Well- Study

Asking for routine exams, the famous check-ups, is normal in any trip to the doctor. However, this practice is dangerous and is not part of the routine when it comes to the health of children and adolescents. Currently, there is an increase in the request for laboratory tests for children, much more than necessary. Unlike adults, exposing children to radiation or unnecessary screening is something to be carefully evaluated.

“We see more and more healthy children or children with specific problems. I see, for example, allergic children who, in addition to the necessary tests to explore this issue and better treat it, a huge number of other tests are requested”, says Professor Magda Carneiro-Sampaio, from the Department of Pediatrics at the Faculty of Medicine from USP and the Institute for Children and Adolescents at Hospital das Clínicas.

She explains that the child’s check-up is already well defined. It is necessary to check physical growth, neuropsychosocial development, education, diet, among other factors. First you talk to the parents, then you are examined, says the doctor. What happens is that normal, healthy children are subjected to more tests than are really necessary, which does not bring any benefit. “A good doctor is not a doctor who asks for an endless list of exams. A good doctor is the one who talks, who tries to really understand what is going on, who continues to think of hypotheses based on what he observes in the physical examination and, if necessary, will order some tests, called complementary ones”, recalls Magda.

When should the exams be done?

Child care is longitudinal and the ideal is to accompany the child from its gestation. All follow-up is very much based on talking with the family and promoting a healthy lifestyle. “There are few exams that have evidence that they bring benefits both for the individual and for society”, warns physician Filumena Maria da Silva Gomes, pediatrician in child development at the institute and dedicated to primary care.

This does not include screening during pregnancy, recalls Filumena: “Theoretically, all children born in Brazil should undergo neonatal screening for the main diseases that exist in the population”. Blood typing tests, serology to identify sexually transmitted diseases, heel prick tests, metabolic screening, among others, are very important.

In healthy children, what is recommended is: after this neonatal screening, the next screening is for anemia, iron deficiency, and then, only at 10 years of age, to find cholesterol and triglycerides. Examinations beyond these have no justification for ordering. The other screenings are in risk groups, such as rickets in prematurity, children with chronic diseases, Down syndrome (thyroid problems).

“We don’t have so many screenings to justify this amount of check-ups and exams done, which end up increasing the costs for families and society”, says Filumena. Parents need to talk to doctors and question the amount of tests requested. As Magda says: “The conversation, which we call anamnesis, is extremely important, because the pediatrician is an educator”. He is responsible for guiding healthy habits, checking for disturbances, behavioral problems.

“The pediatrician has a huge role, a role for life”, says the teacher. The fear is that these routine exams replace complementary exams, and that this ends up influencing the diagnosis of more serious and specific diseases or disorders. Another problem is the lack of close contact between the families and the pediatrician and the failure to establish a relationship of trust.


“The monitoring of the child is always based on a healthy lifestyle tripod”, says Filumena. Medical follow-up has to be focused on this: how she eats, how she exercises and how she sleeps. Most complications in children have a viral origin, but if they have a healthy lifestyle, the body itself will solve it, says the doctor. Laboratory tests will be necessary in cases of complications, in exceptional situations. “With a healthy lifestyle, most children do well, use few medications and rarely need laboratory or radiological tests,” she says.

Filumena warns that “it is not routine for a pediatrician to need to do tests. As I said, the screenings are very few – when they are born, one year, 10 years – and other screenings, only if the child has a personal issue, a specific health problem. Routine is little examination at all”.