Screening blood tests

To detect iron deficiency, clinicians should determine hematocrit or

hemoglobin as follows:

• In term infants: At age 9 to 12 months

• In premature infants: At age 5 to 6 months

• In menstruating adolescents: Annually if they have any of the

following risk factors: moderate to heavy menses, chronic
weight loss, a nutritional deficit, or participation in athletic
activity

Testing for sickle cell disease can be done at age 6 to 9 months if not
done as part of neonatal screening.
Cholesterol screening is indicated for all children between 9 years and 11
years of age and again between 17 years and 21 years of age. Most
useful is a fasting lipid profile. Cholesterol screening is indicated for
children between ages 1 year and 8 years and between ages 12 years
and 16 years only if they have a family history of high cholesterol or
coronary artery disease or risk factors for coronary artery disease (eg,
diabetes, obesity, hypertension).
Hearing tests
Parents may suspect a hearing deficit if their child ceases responding
appropriately to noises or voices or does not understand or develop
speech.
Because hearing deficits impair language development, hearing
problems must be remedied as early as possible. The clinician therefore
should seek parental input about hearing at every visit during early
childhood and be prepared to do formal testing or refer to an audiologist
whenever there is any question of the child’s ability to hear.

Audiometry can be done in the primary care setting; most other

audiologic procedures (eg, otoacoustic emission testing, brain stem
auditory evoked response) should be done by an audiologist.
Conventional audiometry can be used for children beginning at about
age 3 years; young children can also be tested by observing their
responses to sounds made through headphones, watching their
attempts to localize the sound, or observing them complete a simple
task. For older children, audiometry should be done once between 11
and 14 years, once between 15 and 17 years, and once between 18 and
21 years; the testing should include 6,000- and 8,000-Hz high
frequencies.
Tympanometry, another in-office procedure, can be used with children
of any age and is useful for evaluating middle ear function. Abnormal
tympanograms often denote eustachian tube dysfunction or the
presence of middle ear fluid that cannot be detected during otoscopic
examination.
Pneumatic otoscopy is helpful in evaluating middle ear status, but
combining it with tympanometry is more informative than either
procedure alone.
Tuberculosis testing
A tuberculosis screening test using a skin test (tuberculin test) or blood
test (interferon-gamma release assay [IGRA]) should be done if
• Children have been exposed to tuberculosis (eg, to an infected
family member or close contact).

• They have had a family member with a positive tuberculin test.

• They were born in or recently traveled to a high-risk country

(countries other than the United States, Canada, Australia,
New Zealand, or Western and North European countries).

• Their parents or close contacts are new immigrants from a

high-risk country or have been recently incarcerated.

IGRA is preferred for children who are considered unlikely to return to

have their skin test read or for those who have received the BCG vaccine,
which can cause a false-positive skin test result.
AUTISM SPECTRUM DISORDER SCREENING TEST

Diagnosing autism spectrum disorder (ASD) can be difficult because there is

no medical test, like a blood test, to diagnose the disorder. Doctors look at
the child’s developmental history and behavior to make a diagnosis.

ASD can sometimes be detected at 18 months or younger. By age 2, a

diagnosis by an experienced professional can be considered very reliable [1].
However, many children do not receive a final diagnosis until much older.
Some people are not diagnosed until they are adolescents or adults. This
delay means that children with ASD might not get the early help they need.

Early signs of ASD can include, but are not limited to

• Avoiding eye contact,

• Having little interest in other children or caretakers,
• Limited display of language (for example, having fewer words than
peers or difficulty with use of words for communication), or
• Getting upset by minor changes in routine.

Monitoring, screening, evaluating, and diagnosing children with ASD as early

as possible is important to make sure children receive the services and
supports they need to reach their full potential [2]. There are several steps in
this process.

Developmental Monitoring
Developmental monitoring observes how your child grows and changes over
time and whether your child meets the typical developmental milestones in
playing, learning, speaking, behaving, and moving. Parents, grandparents,
early childhood providers, and other caregivers can participate in
developmental monitoring.

Developmental Screening
Developmental screening takes a closer look at how your child is developing.
Your child will get a brief test, or you will complete a questionnaire about
your child. The tools used for developmental and behavioral screening are
formal questionnaires or checklists based on research that ask questions
about a child’s development, including language, movement, thinking,
behavior, and emotions. Developmental screening can be done by a doctor
or nurse, but also by other professionals in healthcare, community, or school
settings.

Comprehensive Developmental Evaluation

A brief test using a screening tool does not provide a diagnosis, but it
indicates if a child is on the right development track or if a specialist should
take a closer look. If the screening tool identifies an area of concern, a
formal developmental evaluation may be needed. This formal evaluation is a
more in-depth look at a child’s development, usually done by a trained
specialist, such as a developmental pediatrician, child psychologist, speech-
language pathologist, occupational therapist, or other specialist. The
specialist may observe the child, give the child a structured test, ask the
parents or caregivers questions, or ask them to fill out questionnaires. The
results of this formal evaluation determines whether a child needs special
treatments or early intervention services or both.