From the Guidelines
For an 18-month-old child, I recommend ordering a complete blood count (CBC), blood chemistries (including serum bilirubin levels), and standard urine studies as part of the initial laboratory assessment. According to the most recent evidence from 1, clinical laboratories should have services appropriate for infant and pediatric needs, including hematologic profiles, blood chemistries, and standard urine studies.
Initial Laboratory Assessment
The following tests are indicated:
- Complete blood count (CBC) to assess for anemia, infection, or other hematologic abnormalities
- Blood chemistries (including serum bilirubin levels) to evaluate liver function and electrolyte balance
- Standard urine studies to assess for urinary tract infection or other renal abnormalities
Additional Considerations
It is essential to consider the child's clinical presentation and medical history when ordering laboratory tests. For example, if the child has a history of congenital heart disease or other underlying medical conditions, additional tests such as electrocardiogram (EKG) or cardiac enzymes may be indicated. However, based on the provided evidence, there is no specific recommendation for these tests in an 18-month-old child without a known medical condition.
Laboratory Facilities
The laboratory facilities should be equipped to process all commonly ordered tests using samples of less than 1 mL ("micro" samples), as recommended by 1. This is particularly important in pediatric patients, where blood sample volumes are limited.
Prioritization of Tests
In the absence of specific clinical indications, the initial laboratory assessment should prioritize tests that are most likely to yield useful information for the diagnosis and management of common pediatric conditions. The tests recommended above are generally considered part of a routine pediatric laboratory assessment and can help identify potential underlying conditions that may require further evaluation or treatment.
From the Research
Labs Indicated for an 18-month-old
- There are limited studies that directly address the specific labs indicated for an 18-month-old child. However, based on the available evidence, some lab tests can be inferred:
- Complete blood count (CBC) and liver function tests (LFTs) may be ordered as part of a routine check-up or if there are concerns about the child's health 2.
- If there are concerns about developmental delays or autism, screening tools such as the Parents' Evaluation of Developmental Status (PEDS), PEDS-Developmental Milestones (PEDS-DM), and Modified Checklist for Autism in Toddlers (M-CHAT) may be used 3.
- In cases of suspected retinoblastoma, magnetic resonance imaging (MRI) and other diagnostic tests may be ordered 4.
- For children with recurrent apneic spells, further evaluation and testing may be necessary to determine the underlying cause 5.
- In cases of traumatic injury, such as craniovertebral instability, imaging studies like radiographs and MRI may be ordered to assess the extent of the injury 6.