Why are pediatricians screening teens for high cholesterol and HIV?

DEAR DOCTOR K:

A friend of mine just took her teenager to the doctor for a checkup. The girl’s cholesterol was checked, and she was tested for HIV. What’s going on? Will my teenage daughter’s pediatrician do the same?

DEAR READER:

The yearly checkup is the perfect time for a doctor to see how kids are growing and give any needed shots. But it’s also an important time to see how they are doing more generally, and to help ensure that they grow into healthy, happy adults.

The American Academy of Pediatrics (AAP) has a checklist for pediatricians called “Recommendations for Preventive Pediatric Health Care.” These recommendations, which are updated every few years, are based on the most up-to-date research about the health of children now — and in the future.

I spoke to my colleague Claire McCarthy, a pediatrician at Boston Children’s Hospital. She mentioned that most of the changes in the latest version of the AAP recommendations pertain to adolescents. Here’s what the AAP thinks pediatricians should be doing with their preteen and teen patients:

  • LIPID SCREENING. High cholesterol (particularly LDL cholesterol) and high triglycerides (another type of fat, or lipid) can damage blood vessels over time and lead to heart disease and stroke. It’s true that heart disease from atherosclerosis (cholesterol-filled plaques) doesn’t usually become apparent until after age 50 or older. However, atherosclerosis actually starts forming in our arteries during our 20s. And it’s more likely to form in teens with high blood levels of LDL cholesterol. For that reason, the AAP now recommends that all youth have their cholesterol checked between the ages of 9 and 11.
  • SCREENING FOR DRUG AND ALCOHOL ABUSE. As we all know, adolescents commonly experiment with drugs and alcohol. For some youth, this can lead to difficult or even deadly consequences. The AAP recommends asking six simple questions that can bring out important information — and allow for important conversations.
  • DEPRESSION SCREENING. Suicide is a leading cause of death among adolescents, and depression is a treatable condition. But to treat it, we need to know that it’s there. Some simple questions can bring out the possibility that a teen may be suffering from depression.
  • HIV TESTING BETWEEN THE AGES OF 16 AND 18. One in four new HIV infections occurs in youth ages 13 to 24 — and 60 percent of all youth with HIV don’t know they are infected. If they don’t know, not only can they not get help, but they can spread the infection to others.

I can imagine some parents saying, “My child doesn’t need these tests.” But when it comes to the health and well-being of our children, it’s always better to be safe than sorry. Sometimes, the best way to protect everyone is to treat everyone the same. When I go through the TSA line at the airport, part of me is annoyed: I know I’m not a terrorist. But I’m glad everyone goes through the line.