From the Guidelines
There are no universal standard guidelines for routine bloodwork frequency in healthy pediatric patients, and bloodwork is typically performed selectively based on risk factors rather than on a fixed schedule. For well children, the American Academy of Pediatrics recommends hemoglobin screening once between 9-12 months of age and again at around 15-18 months for all children, with lead screening at 12 and 24 months for children with risk factors 1. Additional routine bloodwork includes newborn screening (performed shortly after birth), cholesterol screening once between ages 9-11 and again between 17-21, and targeted testing for conditions like anemia or lead poisoning based on risk assessment. Some specific guidelines for routine bloodwork in pediatric patients include:
- Hematocrit or Hemoglobin screening at 12 months of age, and risk assessment to determine if screening is needed at 15 and 30 months of age 1
- Cholesterol screening once between ages 9-11 and again between 17-21 1
- Newborn screening (performed shortly after birth)
- Lead screening at 12 and 24 months for children with risk factors 1 Children with chronic medical conditions require individualized monitoring schedules determined by their specialists. The limited frequency of routine bloodwork in healthy children reflects the balance between detecting important health conditions and avoiding unnecessary testing, which can cause physical discomfort, anxiety, and potential false positive results requiring further investigation. In certain cases, such as biallelic mismatch repair deficiency (BMMRD) syndrome, complete blood count is suggested every 6 months beginning at 1 year of age, although this is a weak recommendation based on very low quality evidence 1. Pediatricians typically order bloodwork when clinically indicated by symptoms, physical exam findings, or specific risk factors rather than as part of standard well-child visits.
From the Research
Routine Bloodwork in Pediatric Patients
The standard guidelines for the frequency of routine bloodwork in pediatric patients are not well-established, as the need for blood tests depends on various factors such as the patient's age, medical history, and underlying conditions. However, some studies provide insights into the frequency of bloodwork in pediatric patients:
- A study published in 2000 2 found that the frequency of triage blood pressure measurements in pediatric patients varied by institution and increased with age.
- Another study published in 2006 3 provided pediatric reference intervals for uncommon bleeding and thrombotic disorders, but did not establish a standard frequency for routine bloodwork.
- A study published in 2016 4 highlighted the challenges and disparities in recognizing and managing elevated blood pressure in pediatric patients, but did not provide guidelines for routine bloodwork.
- A study published in 2008 5 found that abnormal preprocedural coagulation studies were common in pediatric patients, but most cases were due to nonspecific inhibitors rather than underlying bleeding disorders.
- A study published in 1989 6 suggested that routine preoperative blood tests and blood cross-matching are not necessary in healthy children, except in cases where blood transfusion may be required postoperatively.
Factors Influencing Bloodwork Frequency
The frequency of bloodwork in pediatric patients may depend on various factors, including:
- Age: Older children may require more frequent bloodwork due to increased risk of certain medical conditions 2, 3.
- Medical history: Children with underlying medical conditions may require more frequent bloodwork to monitor their condition 4, 5.
- Surgical procedures: Children undergoing major surgery may require preoperative blood tests and blood cross-matching 6.