Screening Tests for Infants
Without symptoms of disease, infants generally do not need many laboratory screening tests once newborn screening tests have been performed during the first week of life. The sections below provide information on the few conditions and diseases for which infants may be screened. They summarize recommendations from various authorities on screening tests for infants, and there is consensus in many areas, but not all. Therefore, when discussing screening with your child’s healthcare provider and making decisions about testing, it is important to consider your infant’s individual health situation and risk factors.
You can find out more about preventive medicine and steps you can take to keep you and your family healthy by reading the companion article Wellness and Prevention in an Era of Patient Responsibility.
Not every infant may need screening for every condition listed here. Read the sections below to learn more about each condition and to determine if screening may be appropriate for your child. You should discuss screening options with your child’s health care practitioner.
Iron Deficiency Anemia
Infants grow and develop rapidly and need iron in their diet to develop normally. For the first 4 to 6 months, an infant can rely on the body’s own storage supply of iron. After that, if an infant does not consume enough iron, there is a risk of developing iron deficiency.
When this happens, the body’s red blood cells suffer and their ability to support the rapidly growing body is affected. Iron deficiency can cause anemia, a condition that can delay an infant’s mental, motor, and behavioral development and create problems that last long after the iron level is raised to a healthy level. Poor motor skills, behavior problems at home and school, and poor performance in school can be the long-term consequences of not receiving enough iron as an infant and young child (0 to 3 years of age).
Early use and overuse of cow’s milk exacerbates existing causes of iron deficiency in infants. Less often, the problem is due to a severe blood loss or something interfering with the body’s ability to absorb iron, such as a medication the infant is taking or a chronic illness involving the stomach or intestines. Premature and low-birth-weight babies are at greater risk. Breast-fed babies usually obtain enough iron, unless the nursing mother’s own supply is low.
The American Academy of Pediatrics (AAP) advises screening all infants for anemia with a hemoglobin test around 12 months of age, along with assessment of risk factors for iron deficiency and iron deficiency anemia.
However, the U.S. Preventive Services Task Force has concluded that the current evidence is insufficient to assess the balance of benefits and harms of screening for iron deficiency anemia in children ages 6 to 24 months.
Like several other organizations, including the U.S. Centers for Disease Control and Prevention (CDC), the AAP recommends that infants and toddlers be screened at any point if they have risk factors, including:
- Premature birth or low birth weight
- Households with a low income or living in poverty
- Exposure to lead
- Exclusive breastfeeding beyond 4 months of age without supplemental iron
- Weaning to whole milk or complementary foods that do not include iron-fortified cereals or foods naturally rich in iron
- Feeding problems, inadequate nutrition
- Poor growth
Sources Used in Current Review (last reviewed 10/27/16)
U.S. Preventive Services Task Force. Iron Deficiency Anemia in Young Children: Screening. Release Date: September 2015. Available online at https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/iron-deficiency-anemia-in-young-children-screening. Accessed October 2016.
Baker RD and Greer FR, The Committee on Nutrition. Diagnosis and Prevention of Iron Deficiency and Iron-Deficiency Anemia in Infants and Young Children (0-3 Years of Age). Pediatrics November 2010, Volume 126 / Issue 5. Available online at http://pediatrics.aappublications.org/content/126/5/1040.full. Accessed October 2016.
Lead is a metal that was once a common additive to household paint and leaded gasoline and was used in water pipes and as a solder in canned foods. Although these uses have been limited in the U.S., the interiors of many houses built before 1978 contain peeling lead paint chips and dust and lead-contaminated water. Soil surrounding these houses may also be contaminated with lead. Children who live, play, or spend time in these environments are at risk of exposure to this metal and can bring lead into their bodies by inhaling or ingesting contaminated dust, water, paint chips, or lead-contaminated items. Other local sources of lead may be areas near industrial or manufacturing sites.
A young child’s exposure to lead can damage the brain and other organs and cause behavioral problems and developmental delays. Even at low levels, lead can cause irreversible damage without causing physical symptoms, and impaired cognitive development may not be noticed until the child enters school.
Poisoning from this environmental hazard usually occurs in early childhood and many children in the United States need to be screened for lead poisoning.
The American Academy of Pediatrics (AAP) recommends that a risk assessment be performed for lead exposure at well-child visits at 6 months, 9 months, 12 months, 18 months, 24 months, and at 3, 4, 5, and 6 years of age. A blood lead level test should be done only if the risk assessment comes back positive. According to the AAP and the U.S. Centers for Disease Control and Prevention (CDC), universal screening or blood lead level tests are no longer recommended, except for children in high prevalence areas with increased risk factors.
Pediatricians may also offer screening to:
- Medicaid-eligible children at age 1 and again at 2 years of age
- Children of all ages who are recent immigrants, refugees, or adoptees at the earliest opportunity
- A child whose parent, guardian, or provider requests blood lead testing due to suspected exposure
People should check with their healthcare practitioner and/or local health department regarding lead screening guidelines specific to the risks in their area.
The CDC uses a threshold blood lead level (BLL) of 5 mcg/dL (five micrograms per deciliter) to identify children living in environments that expose them to lead hazards. Any test results above this level should trigger lead management and monitoring. Any child who has an elevated blood lead level needs to have his or her home or other environment evaluated. Other people at the residence should be tested as well. Without the elimination or reduction of the source of the exposure – a lead hazard in the environment – the elevated lead level will likely recur.
Sources Used in Current Review (last reviewed 9/27/16)
Centers for Disease Control and Prevention. Low Level Lead Exposure Harms Children: A Renewed Call of Primary Prevention. PDF available for download at http://www.cdc.gov/nceh/lead/acclpp/final_document_030712.pdf. Accessed 10/6/2015.
(Updated 6/19/2014) Centers for Disease Control and Prevention. What Do Parents Need to Know to Protect Their Children? Available online at http://www.cdc.gov/nceh/lead/acclpp/blood_lead_levels.htm. Accessed 10/6/2015.
(April 2015) Centers for Disease Control and Prevention. Educational Interventions for Children Affected by Lead. Available online at http://www.cdc.gov/nceh/lead/publications/educational_interventions_children_affected_by_lead.pdf. Accessed 10/6/2015.
American Academy of Pediatrics. Detection of Lead Poisoning. Available online at https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/lead-exposure/Pages/Detection-of-Lead-Poisoning.aspx?nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR:+No+local+token. Accessed October 2016.
Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis bacteria. TB primarily targets the lungs but may affect any area of the body. It can be spread through the air from person to person through droplets of respiratory secretions such as sputum or aerosols released by coughing, sneezing, laughing, or breathing.
Most people who become infected with M. tuberculosis manage to confine the mycobacteria to a few cells in their lungs, where they stay alive but in an inactive form. This latent TB infection does not make the person sick or infectious and, in most cases, it does not progress to active tuberculosis. However, some people – especially those with compromised immune systems – may progress directly from initial TB infection to active tuberculosis. People who have HIV are much more likely to become sick if they contract TB. Another increasing concern is drug-resistant forms of TB that are resistant to the antibiotics typically prescribed to treat the disease.
According to the U.S. Centers for Disease Control and Prevention (CDC), TB in children is a public health concern because it is a marker for recent transmission of the bacteria, and infants and young children are more likely than older children and adults to develop life-threatening forms of the disease.
TB is one of the world’s deadliest diseases, although it is relatively uncommon in the U.S. Still, it is a large health issue among at-risk groups. Current guidelines call for targeted screening among such groups.
Because of their weak immune systems, infants under 2 years of age are especially susceptible to this infection. According to the American Academy of Pediatrics (AAP), testing with a tuberculin skin test is advised for children who are at risk of contracting TB, including:
- If an infant has been exposed to someone with active or suspected TB, such as a family member or other contact
- Is an immigrant from a country where TB is endemic or has traveled to those countries for more than one week
Sources Used in Current Review (last reviewed 10/17/16)
U.S. Centers for Disease Control and Prevention. Tuberculosis (TB) in Children in the United States. Available online at http://www.cdc.gov/tb/topic/populations/tbinchildren/default.htm. Accessed October 2016.
HealthyChildren.org. Tuberculosis in Children. Available online at http://www.healthychildren.org/English/health-issues/conditions/chest-lungs/Pages/Tuberculosis.aspx?nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR%3a+No+local+token. Accessed October 2016.
American Academy of Pediatrics. 2014 Recommendations for Pediatric Preventive Health Care. Pediatrics March 2014, VOLUME 133 / ISSUE 3. Available online at http://pediatrics.aappublications.org/content/133/3/568. Accessed October 2016.
2016 Pediatric Preventive Care Guidelines. Massachusetts Health Quality Partners. Available online through https://www.harvardpilgrim.org/. Accessed October 2016.