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Improving children's health through better pediatric reference intervals

In July 2023, we changed our name from AACC (short for the American Association for Clinical Chemistry) to the Association for Diagnostics & Laboratory Medicine (ADLM). The following page links to resources that were written prior to the rebranding and/or mentions events that took place prior to the rebranding and that contain mentions of the association’s old name.

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.

ADLM 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, 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

Letters to Congress

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 Academy of Pediatrics
American Association of Nurse Practitioners
American Clinical Laboratory Association
American College of Clinical Pharmacy
American Medical Technologists
American Society for Clinical Laboratory Science
American Society for Clinical Pathology
American Society of Andrology
American Society of Hematology
American Society of Pediatric Hematology/Oncology
American Urological Association
Ann & Robert H. Lurie Children’s Hospital of Chicago
Arkansas Children's Hospital
ARUP Laboratories
Association for Academic Pathology
Association of Pediatric Hematology/Oncology Nurses
Association of Public Health Laboratories
Association of Schools and Programs of Public Health
Avalon Healthcare Solutions
Children’s Healthcare of Atlanta
Children’s Hospital Association
Children’s Hospital Colorado
Children’s Hospital of Philadelphia
Children’s National Hospital
Children’s Pathology Chiefs
Children’s Wisconsin
COLA, Inc.
College of American Pathologists
Endocrine Society
International Society of Andrology
Laboratory Corporation of America Holdings
National Association of Pediatric Nurse Practitioners
National Hispanic Medical Association
National Rural Health Association
Nationwide Children’s Hospital
PCOS Challenge: The National Polycystic Ovary Syndrome Association
Pediatric Endocrine Society
Phoenix Children’s Hospital
Quest Diagnostics
Seattle Children's Hospital
Siemens Healthineers
Society for Pediatric Pathology
Society for Reproductive Investigation
University of Pittsburgh Medical Center (UPMC) Health System
Vanderbilt Health
West Virginia University Medicine Children’s Hospital
Yale New Haven Children’s Hospital