Choosing Wisely Canada

The Canadian Paediatric Society is a proud partner of the Choosing Wisely Canada campaign.

Choosing Wisely Canada helps clinicians and patients engage in conversations about unnecessary tests and treatments, and make smart and effective care choices. It is modeled after the Choosing Wisely® campaign in the United States.

Choosing Wisely lists are developed by professional societies representing different clinical specialties. The recommendations identify tests and treatments commonly used in each specialty that are not supported by evidence, and could expose patients to harm.

In 2016, the Canadian Paediatric Society developed its own Choosing Wisely Canada list.

The Canadian Paediatric Society lists five recommendations:

• Don’t routinely use acid blockers or motility agents for the treatment of gastroesophageal reflux in infants.
• Don’t perform screening panels (IgE tests) for food allergies without previous consideration of the pertinent medical history.
• Don’t administer psychostimulant medications to preschool children with Attention Deficit Disorder (ADD), but offer parent-administered behavioural therapy.
• Don’t routinely do a throat swab when children present with a sore throat if they have a cough, rhinitis, or hoarseness as they almost certainly have viral pharyngitis.
• Don’t recommend the use of cough and cold remedies in children under six years of age.

For background and references for each recommendations, visit Choosing Wisely Canada or download the PDF.

How was the CPS list established?

The Canadian Paediatric Society established its Choosing Wisely Canada list through the leadership of a seven-member task force. CPS Committees and Sections were consulted about items they felt should be included in the campaign. The CPS also consulted existing lists from the American Academy of Pediatrics, and the Society of Hospital Medicine. It also looked at current CPS position statements.

Using Delphi methodology, the task force submitted a list of seven topics to the CPS Board. Principles used to inform decision-making included:

a) is lack of effectiveness of the test, intervention or treatment well supported by evidence;

b) is there evidence of harm resulting from unnecessary use of the test, intervention or treatment; and

c) is the test, intervention or treatment used commonly by physicians and health care workers treating children across Canada.

The list was reviewed by the CPS Board and Executive and was narrowed down to five items.

Other Choosing Wisely Canada lists relevant to paediatrics:

• Emergency medicine (Canadian Association of Emergency Physicians)
• Family medicine (College of Family Physicians of Canada)
• Infectious disease (Association of Medical Microbiology and Infectious Disease Canada)
• Medical education (Resident Doctors of Canada)
• Obstetrics and gynaecology (Society of Obstetricians and Gynaecologists of Canada)
• Paediatric surgery (Canadian Association of Paediatric Surgeons)
• Psychiatry (Canadian Academy of Child and Adolescent Psychiatry, Canadian Academy of Geriatric Psychiatry, Canadian Psychiatric Association)
• Radiology (Canadian Association of Radiologists)
• Respiratory medicine (Canadian Thoracic Society)
• Sport and exercise medicine (Canadian Academy of Sport and Exercise Medicine)

Choosing Wisely US lists of interest:

• American Academy of Pediatrics
• Society of Hospital Medicine – pediatric list