Choosing Wisely Examines Pediatric Surgical Practices to Avoid

By Kelly Young

Edited by Susan Sadoughi, MD, and Richard Saitz, MD, MPH, FACP, DFASAM

The American Academy of Pediatrics has released five practices in pediatric surgery that clinicians and patients should question, as part of the Choosing Wisely campaign. Here they are, in brief:

• Whole-body computed tomography (CT) scans should be avoided in pediatric trauma patients.

• For children with suspected appendicitis, CT should not be the first-line imaging choice. Ultrasound should be performed, and if results are equivocal, CT or magnetic resonance imaging (MRI) may be used.

• Concurrent fundoplications should be avoided during gastrostomy placement in most pediatric patients who are thriving with gastric feedings.

• Most children with umbilical hernias should not be referred to a pediatric surgeon until they are 4 to 5 years old.

• Avoid unnecessary postoperative opioid use. Fewer opioids can be used when children are concurrently given acetaminophen and/or nonsteroidal anti-inflammatory drugs after surgery.