A recent systematic review identified several established as well as emerging practices utilized in the pediatric setting that were associated with overuse of medical care, which could potentially lead to patient harm and increased healthcare costs. 

The literature review aimed to identify areas of medical overuse occurring in the pediatric setting in 2018. Articles pertaining to this subject were obtained by an electronic search of MEDLINE and Embase as well as a manual search of the table of contents of selected pediatric journals. Three independent raters evaluated each article for its quality of methods, degree of potential harm, and quantity of patients potentially harmed. 

Following review, a total of 10 articles were selected for inclusion based on their scores and assessment of overall potential harm. “This year’s review of the pediatric medical overuse literature features articles that highlight both established and emerging practices that warrant scrutiny and possibly deimplementation,” the authors stated.

Established practices identified as potential medical overuse included use of antibiotics as prophylaxis for urinary tract infections, routine prescribing of opioids, prolonged courses of antibiotics for latent tuberculosis, intensive care admission with pharmacological treatment for neonatal abstinence syndrome, and the misdiagnosis of attention-deficit/hyperactivity disorder in those who may just be young for their grade. 

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Emerging practices that were identified to warrant further evaluation and prevention of widespread use included nurse-led home visits following discharge, probiotic use for gastroenteritis, and programs for intensive cardiac screening for athletes. 

“Deimplementation of disproven practices and careful examination of emerging practices are imperative to prevent unnecessary resource use and patient harm,” the authors concluded.


Money NM, Schroeder AR, Quinonez RA, et al. 2019 Update on Pediatric Medical Overuse: A Systematic Review. JAMA Pediatr. Published online February 03, 2020. doi:10.1001/jamapediatrics.2019.5849.