Baby Development New York Times Reports: Plenty of Guidelines, But Where's the Evidence?
Posted Dec 20 2008 5:53pm
By Colleen Hurley, RD, Certified Kids Nutrition Specialist
If you are an avid researching parent, no doubt you at some point become confused and even frustrated by all the conflicting information in media on the best practices for caring for babies and children. In past year, we have seen many reversals on public stances for childcare as well as highly public changes of opinion by many leading health experts. The New York Times reports on that very topic and the need to enhance evidence based healthcare guidelines.
New studies are being born all the time and few physicians have the time read, let alone understand it all. Groups of both private and public organizations help doctors out by streamlining research and providing updated clinical guidelines or methods of best practice for everything from the sniffles to heart disease.
These groups can have a vast influence on medical practices by creating national standards of care, however, the road to guideline creation tends to be arduous and often prone to error. These inconsistencies often lead to a sudden change in public recommendations leaving doctors and parents alike feeling confused, especially when it comes to childrens health.
Taking a look at this past year, for example, the American Academy of Pediatrics (AAP) drastically switched gears on a few important topics. For one, the AAP reversed their statement regarding infant avoidance of peanuts and other food allergies without the mention of any new evidence. While the American Heart Association recommended children taking medications for attention deficit disorder get cardiac testing, the AAP publicly dismessed the necessity for such testing. Most recently, the AAP lowered the age in which cholesterol levels should be checked in children including reducing the age in which children should take prescription medication for elevated cholesterol levels.
While these organizations must review their guidelines every 5 years, many clinical reports are thousands of pages long leaving doctors and other advisors to cite lack of time as a big factor. Clinical guidelines were established in the 1980s as a result of large insurance companies like Medicare to streamline cost of care and treatment protocols. Unfortunately, many of the pediatric recommendations are not often based on scientific evidence. This lack of consistency with the care of children, who are a vulnerable population, leaves parents frustrated. Shifting to standardized physician care with pay for performance incentives by insurance companies may force more doctors to take a harder look at the current guidelines, but until then better standards for creating these guidelines must be instilled.