What laboratory tests are recommended for an 11-year-old well child visit?

Recommended Laboratory Tests for an 11-Year-Old Well Child Visit

A fasting lipid profile is the primary laboratory test recommended for an 11-year-old well child visit, as this age represents a key screening point for dyslipidemia before puberty-related changes occur. 1, 2

Core Laboratory Recommendations

• Lipid Screening: A nonfasting non-HDL cholesterol level is recommended for all children between ages 9-11 years, with confirmatory fasting lipid panel if abnormal 1, 2
• Blood Pressure Measurement: While not a laboratory test, blood pressure should be measured and compared to age, sex, and height percentiles 1
• Hemoglobin/Hematocrit: Consider risk assessment to determine if screening is needed at this age (universal screening was previously done at 12 months) 1, 3

Risk-Based Laboratory Testing

For children with specific risk factors, additional testing may be warranted:

• Fasting Blood Glucose/HbA1c: For children with obesity or other metabolic risk factors 1
• Urinalysis: Consider for baseline assessment of kidney function, though not universally recommended at this specific age 4, 5
• Thyroid Function Tests: For children with family history of thyroid disease or symptoms suggestive of thyroid dysfunction 1

Rationale for Lipid Screening at Age 11

The American College of Cardiology/American Heart Association specifically recommends ages 9-11 years for universal lipid screening because:

• Lipid levels are relatively stable before puberty 2
• Atherosclerotic changes begin to diverge between affected and unaffected children around age 10 years 1, 2
• Early identification allows for lifestyle interventions and family screening for familial hypercholesterolemia 1

Special Considerations

• Family History: Children with family history of early cardiovascular disease or significant hypercholesterolemia should have already had lipid screening performed as early as age 2 years 1, 2
• Obesity: Children with obesity should have additional metabolic screening including liver function tests (AST/ALT) to screen for fatty liver disease 1
• Diabetes: Children with diabetes require more comprehensive laboratory monitoring including lipids, thyroid function, and celiac screening 1

Follow-up Recommendations

• If initial LDL cholesterol is ≤100 mg/dL, subsequent testing should be performed between ages 17-21 years 1, 2
• If LDL cholesterol values are within accepted risk levels (<100 mg/dL), repeating the lipid profile every 3 years is reasonable 1, 2
• For abnormal results, follow-up should include lifestyle counseling and potential referral to a specialist for severe abnormalities 1

Common Pitfalls to Avoid

• Over-testing: Not all laboratory tests are recommended for every child at this age; testing should be guided by risk factors and clinical judgment 1
• Inadequate follow-up: Abnormal lipid values require appropriate follow-up and intervention, not just documentation 1, 2
• Relying solely on point-of-care testing: For hemoglobin screening, point-of-care testing may overestimate anemia compared to formal laboratory testing 6