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Improving Children's Health Through Better Pediatric Reference Intervals

Reference intervals are the range of normal test values appropriate for a healthy individual and are vital for the proper interpretation of medical test results and accurate diagnoses. Clinicians rely on them to inform their treatment decisions and more precise reference intervals mean better patient outcomes.

Laboratories establish reference intervals using patient samples collected for testing. Different intervals are developed for different ages, genders, ethnicities, and on the basis of other factors, which allows healthcare providers to determine what normal test results should be for a variety of demographics. For intervals to be accurate, enough samples need to be collected to be representative of these various demographics.

The wide availability of samples from adults makes it easy for laboratories to establish quality reference intervals for adult groups. However, the establishment of quality reference intervals for pediatric groups has been a major challenge. Many samples that laboratories have for the youngest demographics are taken from children who are being tested for a medical condition or illness. This means that while general reference ranges can be established using these samples, they are not representative of healthy populations.

Initiatives such as the Children’s Health Improvement through Laboratory Diagnostics (CHILDx) program initiated by ARUP Laboratories and the University of Utah Department of Pathology, as well as the Canadian Laboratory Initiative in Pediatric Reference Intervals (CALIPER) have made great strides improving children’s reference intervals. However, the large scope of the problem means much more work needs to be done.

The Association for Diagnostics & Laboratory Medicine (formerly AACC) is leading an ad hoc coalition of major healthcare groups that includes several pediatric organizations and medical device manufacturers in an effort to address this issue. Together, the association and its partners are working with lawmakers, their staff, and other stakeholders to improve the quality of children’s healthcare.

ADLM Position Statement on Pediatric Reference Intervals

In this position statement, the Association for Diagnostics & Laboratory Medicine (ADLM) calls on Congress to fund efforts to obtain specimens from healthy children, which can be used to develop precise reference intervals.

Additional Resources

Policy Report

Policy Brief

Fact Sheet

Congressional Briefing

Left: Dr. Dennis Dietzen speaks about the importance of improving pediatric reference intervals at ADLM’s February 27, 2019 congressional briefing.

View the congressional briefing presentations:
Presentations on Improving Pediatric Reference Intervals

From Other Organizations

ADLM's Pediatric Reference Interval Partners

ADLM would like to thank the following organizations for their support of the association's efforts to improve children's reference intervals.

Academy of Clinical Laboratory Physicians and Scientists

American Urological Association

American Academy of Pediatrics

ARUP Laboratories

Quest Diagnostics
American Clinical Laboratory Association Association of Pediatric Hematology/Oncology Nurses College of American Pathologists
Seattle Children's Hospital
American Medical Technologists Association of Public Health Laboratories Endocrine Society
Siemens Healthineers
American Society for Bone and Mineral Research

Children's Healthcare of Atlanta

Laboratory Corporation of  America Holdings  

Society for Reproductive Investigation
American Society for Clinical Laboratory Science

Children's Hospital Association

National Association of Pediatric Nurse Practitioners  Thermo Fisher Scientific
American Society for Clinical Pathology

Children's Hospital of Philadelphia


PCOS Challenge: The National Polycystic Ovary Syndrome Association

American Society of Hematology

Children’s National Hospital

Pediatric Endocrine Society

American Society of Pediatric Hematology/Oncology

Children's Pathology Chiefs