Paediatrics
Canadian Paediatric Society
Last updated: October 2025
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Medications that decrease acidity in the stomach do not improve infants’ crying or spitting up. These symptoms are common and usually improve on their own, as the child grows up. Studies show that infants who take medications that block stomach acid secretion have more respiratory and gastrointestinal infections. Motility agents do not improve symptoms of reflux in infants but they can have side effects on the heart and nervous system, as well as dangerous interactions with other medications. For example, domperidone can increase the QTc interval on the EKG, particularly when used with other medications that affect liver metabolism, and metaclopromide can cause tardive dyskinesia. Infants with gastroeosophageal reflux and poor growth, who have recurrent respiratory problems or who bleed from their gastrointestinal tract, need further evaluation and may need medication. However, most infants will not need them.
Sources:
Antonio B, et al. Gastroesophageal reflux in infants and children: diagnosis and treatment. Am Fam Physician 2025;111(1):62-72. PMID: 39823617.
Chevalier I, et al. Medical management of gastroesophageal reflux in healthy infants. Paediatr Child Health 2022 Dec 27;27(8):504-511. PMID: 36583075.
Cuzzolin L, et al. Clinical use of gastric antisecretory drugs in pediatric patients with gastroesophageal reflux disease: a narrative review. Transl Pediatr. 2023 Feb 8;12(2): 260-70. PMID: 36891365.
Rosen R, et al. Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr. 2018 Mar;66(3):516-554. PMID: 29470322.
Tighe MP, et al. Pharmacological treatment of gastro-oesophageal reflux in children. Cochrane Database Syst Rev. 2023 Aug 22;8(8):CD008550. PMID: 37635269.
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Allergy tests for food may be falsely positive when they are performed in children who don’t have a history suggesting a serious (IgE-mediated) allergy to that food. These results can lead to avoidance of foods to which a true allergy has not been validly documented. When symptoms suggest a food allergy, a careful history should be completed before ordering specific tests, and these should be selected based on the history. A history that suggests serious allergy to a food may include: (1) combinations of the skin, ocular, respiratory, gastrointestinal and cardiovascular symptoms of anaphylaxis that occur within minutes to hours of eating the specific food, or (2) moderate to severe atopic dermatitis. Testing should be selected based on the history and should not include large screening panels.
Sources:
Al Ghamdi A, et al. Canadian Society of Allergy and Clinical Immunology position statement: panel testing for food allergies. Allergy Asthma Clin Immunol. 2024 Nov 29;20(1):61. PMID: 39614376.
Opper C, et al. Diagnosis of Immunoglobulin E-Mediated Food Allergy. Immunol Allergy Clin North Am. 2025 Aug;45(3):339-354. Epub 2025 Jun 13. PMID: 40669936.
Riggioni C, et al. Systematic review and meta-analyses on the accuracy of diagnostic tests for IgE-mediated food allergy. Allergy. 2024 Feb;79(2):324-352. Epub 2023 Nov 27. PMID: 38009299.
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The treatment of preschool-aged children with ADHD should involve evidence-based parent-focused behavioural therapy first, as it confers enhanced parent-reported self-efficacy and may help reduce disruptive behaviours. Preschool-aged children are more sensitive to psychostimulant side effects, including the potential for reduction in growth velocity, in a small subset of children.
Sources:
Feldman ME, et al. ADHD in children and youth: Part 2-Treatment. Paediatr Child Health. 2018 Nov;23(7):462-472. Epub 2018 Oct 24. PMID: 30681665.
Feng M, et al. Behavior Management Training for Parents of Children with Preschool ADHD Based on Parent-Child Interactions: A Multicenter Randomized Controlled, Follow-Up Study. Behav Neurol. 2023 Sep 11;2023:373563. PMID: 37727252.
Dekkers TJ, et al. Meta-analysis: Which Components of Parent Training Work for Children With Attention-Deficit/Hyperactivity Disorder? J Am Acad Child Adolesc Psychiatry. 2022 Apr;61(4):478-494. Epub 2021 Jul 2. PMID: 34224837.
National Institute for Health and Care Excellence (NICE). Attention deficit hyperactivity disorder: diagnosis and management. [Internet] 14 March 2018 [cited 2025].
Rimestad ML, et al. Short- and Long-Term Effects of Parent Training for Preschool Children With or at Risk of ADHD: A Systematic Review and Meta-Analysis. J Atten Disord. 2019 Mar;23(5):423-434. Epub 2016 May 14. PMID: 27179355.
Wolraich ML, et al. Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents. Pediatrics. 2019 Oct;144(4):e20192528. Erratum in: Pediatrics. 2020 Mar;145(3):e20193997. PMID: 31570648.
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Children presenting with sore throats accompanied by symptoms highly indicative of a viral illness—such as rhinorrhea, cough, oral ulcers, or hoarse voice—are unlikely to have Group A Streptococcus (GAS) pharyngitis. Given that many children are asymptomatic carriers of GAS, diagnostic testing may result in misdiagnosis and unwarranted antibiotic treatment, as current tests typically cannot differentiate between acute infection and GAS carriage.
Sources:
Cohen JF, et al. Group A Streptococcus pharyngitis in Children: New Perspectives on Rapid Diagnostic Testing and Antimicrobial Stewardship. J Pediatric Infect Dis Soc. 2024 Apr 24;13(4):250-256. PMID: 38456797.
Sauve L, et al. Group A streptococcal pharyngitis: A practical guide to diagnosis and treatment. Paediatr Child Health. 2021 Jul 28;26(5):319-320. PMID: 34336062.
Shapiro DJ, et al. Viral Features and Testing for Streptococcal Pharyngitis. Pediatrics. 2017 May;139(5):e20163403. Epub 2017 Apr 4. PMID: 28557742.
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Cough and cold remedies sold over the counter often contain combinations of several medications. Research shows that they are not effective when given to children. They can, however, cause serious harmful effects, including accidental overdose, particularly when combined with other medications. For these reasons, since 2008, Health Canada has advised against their use in children less than six years of age.
Sources:
Bell EA, et al. Over-the-counter cough and cold medications in children: are they helpful? Otolaryngol Head Neck Surg. 2010 May;142(5):647-50. PMID: 20416449.
Clark G, et al. Cough medicines for children- time for a reality check. Paediatr Respir Rev. 2023 Dec;48:30-38. Epub 2023 Aug 17. PMID: 37718235.
Isbister GK, et al. Restricting cough and cold medicines in children. J Paediatr Child Health. 2012 Feb;48(2):91-8. Epub 2010 Jun 27. PMID: 20598066.
Smith SM, et al. Over-the-counter (OTC) medications for acute cough in children and adults in ambulatory settings. Cochrane Database Syst Rev. 2012 Aug 15;(8):CD001831. Update in: Cochrane Database Syst Rev. 2014 Nov 24;(11):CD001831. PMID: 22895922.
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The Canadian Paediatric Society (CPS) established its Choosing Wisely Canada list through the leadership of a 7-member task force. CPS Committee Chairs and Section Presidents were consulted and sought input from committee and section executive members about items they felt should be included in the campaign. They were made aware of the American Academy of Pediatrics’ list as well as the Society of Hospital Medicine’s Pediatric Hospital Medicine list, published through the American Choosing Wisely® campaign. Current CPS statements were also considered during list development. Committees’ and sections’ submissions were reviewed by the task force. Using Delphi methodology, the task force established a list of 7 topics that were submitted to the CPS Board, including some recommendations that were previously made by other medical associations or societies. Principles used to inform decision-making were the following: 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; 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.
Sources:
Antonio B, et al. Gastroesophageal reflux in infants and children: diagnosis and treatment. Am Fam Physician 2025;111(1):62-72. PMID: 39823617.
Chevalier I, et al. Medical management of gastroesophageal reflux in healthy infants. Paediatr Child Health 2022 Dec 27;27(8):504-511. PMID: 36583075.
Cuzzolin L, et al. Clinical use of gastric antisecretory drugs in pediatric patients with gastroesophageal reflux disease: a narrative review. Transl Pediatr. 2023 Feb 8;12(2): 260-70. PMID: 36891365.
Rosen R, et al. Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr. 2018 Mar;66(3):516-554. PMID: 29470322.
Tighe MP, et al. Pharmacological treatment of gastro-oesophageal reflux in children. Cochrane Database Syst Rev. 2023 Aug 22;8(8):CD008550. PMID: 37635269.
Al Ghamdi A, et al. Canadian Society of Allergy and Clinical Immunology position statement: panel testing for food allergies. Allergy Asthma Clin Immunol. 2024 Nov 29;20(1):61. PMID: 39614376.
Opper C, et al. Diagnosis of Immunoglobulin E-Mediated Food Allergy. Immunol Allergy Clin North Am. 2025 Aug;45(3):339-354. Epub 2025 Jun 13. PMID: 40669936.
Riggioni C, et al. Systematic review and meta-analyses on the accuracy of diagnostic tests for IgE-mediated food allergy. Allergy. 2024 Feb;79(2):324-352. Epub 2023 Nov 27. PMID: 38009299.
Feldman ME, et al. ADHD in children and youth: Part 2-Treatment. Paediatr Child Health. 2018 Nov;23(7):462-472. Epub 2018 Oct 24. PMID: 30681665.
Feng M, et al. Behavior Management Training for Parents of Children with Preschool ADHD Based on Parent-Child Interactions: A Multicenter Randomized Controlled, Follow-Up Study. Behav Neurol. 2023 Sep 11;2023:373563. PMID: 37727252.
Dekkers TJ, et al. Meta-analysis: Which Components of Parent Training Work for Children With Attention-Deficit/Hyperactivity Disorder? J Am Acad Child Adolesc Psychiatry. 2022 Apr;61(4):478-494. Epub 2021 Jul 2. PMID: 34224837.
National Institute for Health and Care Excellence (NICE). Attention deficit hyperactivity disorder: diagnosis and management. [Internet] 14 March 2018 [cited 2025].
Rimestad ML, et al. Short- and Long-Term Effects of Parent Training for Preschool Children With or at Risk of ADHD: A Systematic Review and Meta-Analysis. J Atten Disord. 2019 Mar;23(5):423-434. Epub 2016 May 14. PMID: 27179355.
Wolraich ML, et al. Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents. Pediatrics. 2019 Oct;144(4):e20192528. Erratum in: Pediatrics. 2020 Mar;145(3):e20193997. PMID: 31570648.
Cohen JF, et al. Group A Streptococcus pharyngitis in Children: New Perspectives on Rapid Diagnostic Testing and Antimicrobial Stewardship. J Pediatric Infect Dis Soc. 2024 Apr 24;13(4):250-256. PMID: 38456797.
Sauve L, et al. Group A streptococcal pharyngitis: A practical guide to diagnosis and treatment. Paediatr Child Health. 2021 Jul 28;26(5):319-320. PMID: 34336062.
Shapiro DJ, et al. Viral Features and Testing for Streptococcal Pharyngitis. Pediatrics. 2017 May;139(5):e20163403. Epub 2017 Apr 4. PMID: 28557742.
Bell EA, et al. Over-the-counter cough and cold medications in children: are they helpful? Otolaryngol Head Neck Surg. 2010 May;142(5):647-50. PMID: 20416449.
Clark G, et al. Cough medicines for children- time for a reality check. Paediatr Respir Rev. 2023 Dec;48:30-38. Epub 2023 Aug 17. PMID: 37718235.
Isbister GK, et al. Restricting cough and cold medicines in children. J Paediatr Child Health. 2012 Feb;48(2):91-8. Epub 2010 Jun 27. PMID: 20598066.
Smith SM, et al. Over-the-counter (OTC) medications for acute cough in children and adults in ambulatory settings. Cochrane Database Syst Rev. 2012 Aug 15;(8):CD001831. Update in: Cochrane Database Syst Rev. 2014 Nov 24;(11):CD001831. PMID: 22895922.
About Choosing Wisely Canada
Choosing Wisely Canada is the national voice for reducing unnecessary tests and treatments in health care. One of its important functions is to help clinicians and patients engage in conversations that lead to smart and effective care choices.
Web: choosingwiselycanada.org
Email: info@choosingwiselycanada.org
Twitter: @ChooseWiselyCA
Facebook: /ChoosingWiselyCanada
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