How come that in the first months of life the only control, besides the normal ones of the pediatrician, is limited to verifying with an ultrasound the state of the hip? Are cardiac, pulmonary, etc., not planned visits performed with modern technologies that are not dangerous for a newborn, such as ultrasound scans, tac or other?
To look for a disease situation, it is necessary to start from some concrete element. In Pediatrics it is correct to carry out investigations (of blood, instrumental or visits) only when a diagnostic suspicion exists . Otherwise, the possibility of obtaining false positive results and starting a vicious circle of further checks increases.
This rule, which is not found in the medicine of adults or the elderly, depends on the fact that children do not normally suffer from chronic diseases and therefore the possibility of intercepting one in an apparently healthy child is less than the probability of committing an error in the examination . In other words, more errors than information are collected by doing carpet exams in healthy children. On the contrary, if a significant symptom appears, the propensity to aim at something concrete becomes sufficiently consistent to make the assessment useful and meaningful.
Screening
The issue of screening is different, ie mass checks on the healthy population (such as ultrasound for hip dysplasia or hypothyroidism at birth). These, to have a meaning, must respond to precise criteria of opportunity. In summary, we can say that it is worthwhile to use resources in a screening only when:
- these are serious pathologies
- these are frequent pathologies
- it is possible to diagnose them with certainty with a simple method
- it is possible to intervene on the course of the disease with an early therapeutic intervention
- the costs are entirely compatible with the resources (and cannot be better allocated elsewhere).
None of the assessments proposed by you meet these criteria: it is therefore not appropriate for public health to take them into consideration.
Finally, two observations. The CT scan is anything but a harmless examination (regardless of the fact that it is also very expensive): it consists of a series of radiographs performed in layers and, if the affected area is large, represents a very considerable radiation load, justified only for a serious diagnostic suspicion.
Pediatrician health budgets
The “normal visits” of the Pediatrician represent instead the most complete and precious instrument through which the child’s health is guaranteed and controlled: With an overall very low cost (about a fifteenth of the total per capita health expenditure, that is, how much the State spends in healthcare for each of us: medicines, hospitals, exams, ASL employees, etc.), children are guaranteed continuity of care by a specialized professional, available in case of illness and vigilant in health control.
Even with the limitations of generalization, so certainly someone can report non-positive experiences, however, the Italian family Pediatrics represents a showpiece in the not always clear panorama of our health.