new pedi preventive health recs

the am acad of pediatrics just came out with new pediatric preventive care guidelines (see pedi preventive health recs 2014 in dropbox, or go to http://pediatrics.aappublications.org/content/early/2014/02/18/peds.2013-4096.full.pdf). the guidelines are basically a chart of either things to do on all kids, or targeted assessments -- risk assessment with appropriate action to follow if positive. the basic changes are:

development/behavior:

        --depression screen yearly from ages 11 through 21, esp using PHQ-2

      --alcohol and drug screen yearly from ages 11 through 21, esp using CRAFFT (this is to do targeted assessment, with appropriate action if positive)

procedures:

         --lipid screening: targeted at age 24 mo, 2 y, 4 y, 6 y, 8 y, then once for all kids aged 9-11 y (this is the new recommendation), then targeted annually from 12-17 y, then again once for all kids aged 18-21 y 

        --hematocrit/hgb: targeted by risk assessment at 4 mo, all kids at 12 mo, then targeted at every well-child visit thereafter (added 15 and 30 month targeted screen)

        --STI/HIV screen: targeted annually age 11-15, then once in all kids aged 16-18, then targeted annually thereafter (HIV screen was added in the 16-18 year range)

        --cervical screen/pap: age 21, all girls. not before age 21 (consistent with other recommendations)

so, all seems reasonable to me, except i have concerns about over-testing for lipids. the real goal for the 9-11 yo screen i think is to pick up kids with severe familial dyslipidemia. i agree that many kids should be retested in late adol/early adulthood (when they are at an age to be more responsible in dietary and other lifestyle changes), though kids who actually have pristine lipids at age 9-11 and eat well/are not obese/are athletic (yes, there are some...) probably do not need a repeat lipid test 9 or 10 years later, esp girls who, even with awful diet, are pretty well protected from atherosclerotic disease until middle adulthood.