Choosing Wisely: Five Things Physicians and Patients Should Question Related to Pediatric Environmental Health

Posted on May 18, 2021

ITASCA, IL -- The American Academy of Pediatrics (AAP), as part of the Choosing Wisely® campaign, has released a list of common medical tests, therapies and practices related to children and environmental health that may be unnecessary and should be considered carefully by physicians and parents.

The AAP Council on Environmental Health compiled the list of issues, some of which are based on myths about the causes of autism that lack evidence and may be harmful. The council described treatments that parents may question that are encountered in pediatric settings and emergency departments by pediatricians, pediatric medical subspecialists and surgical specialists.

“Every day, we come into contact with chemicals that are in our food, air, water, soil, dust, or the products we use. Not all of these are bad or cause for concern, and ultimately, it’s stronger regulatory practices that are most important for minimizing our exposure to harmful chemicals,” said Aparna Bole, MD, FAAP, chair of the AAP Council on Environmental Health. “Tests or treatments that claim to diagnose childhood diseases based on chemical measurements may be misleading or based on a false premise. Pediatricians can help address parents’ concerns about chemical exposures, and we encourage parents to talk with their pediatricians before pursuing any of these tests.”

The Council’s executive committee recognizes there are unique considerations and options as it concerns children. The list is available here and includes:

  1. Do not routinely test urine for metals and minerals in children with autistic behaviors. Toxicologic exposures have not been conclusively associated with the development of autistic behaviors in children. Testing for metals and minerals may be harmful if treatment is guided on the basis of these results.
  2. Do not order hair analyses for “environmental toxins” in children with behavioral or developmental disorders, including autism.
  3. Do not order mold sensitivity testing on patients without clear allergy or asthma symptoms (particularly those with chronic fatigue, arthralgia, cognitive impairments, and affective disorders). For those with allergy or asthma symptoms who have not responded to environmental interventions to reduce allergen exposures, mold sensitivity testing may be performed by an allergist pulmonologist, or any other qualified provider, but should not routinely be performed in the primary care setting.
  4. Do not order “chelation challenge” urinary analyses for children with suspected lead poisoning.
  5. With the exception of certain heavy metals (eg, lead), do not routinely use measurements of environmental chemicals in a person’s blood or urine to make clinical decisions.

The list, Five Things Physicians and Patients Should Question, is available through the Choosing Wisely website. Choosing Wisely® is an initiative of the ABIM Foundation, which seeks to promote conversations between clinicians and patients in choosing care that is supported by evidence; does not duplicate other tests or procedures already received; is free from harm; and truly necessary.

At least 80 medical specialty societies have published more than 500 recommendations of overused tests and treatments as a result of the initiative, launched in 2012.


The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit