Overdiagnosis in paediatrics

Regular readers of the BMJ will be aware of their recent focus on ‘too much medicine’; ie, the harms that come from diagnosing and treating things that don't matter. To complement this, Pediatrics has published a thoughtful article relating to children (Coon E and colleagues. 2014. doi:10.1542/peds.2014–1778). Although much of the debate stems from screening adults for cancer, hypertension etc, there is also an issue for us. The article gives numerous examples of potential overdiagnoses with resultant harms: radiation exposure from CT scans for head injuries; unnecessary admission from low oxygen saturations in bronchiolitis; normal behaviour in pre-schoolers being diagnosed as ADHD. They describe how the harms can be shown to go beyond the tests themselves to altering family behaviour: parents of neonates treated for benign jaundice perceive their baby as ‘ill’ even when it has resolved. They reflect on why physicians behave this way, and what can be done to reverse the trend, for example through medical education.

Although the writers come from the US, we in the UK should not be complacent. It may be more of a problem there because …