AIMSTo investigate the extent and timing of diurnal variation in stature and to examine the effectiveness of the stretched technique in reducing the loss in height.
SETTINGA Southampton school.
DESIGNFifty three children, divided into two groups, were measured by two independent auxologists using a Leicester height measure. Each child was measured four times, at 0900, 1100, 1300, and 1500, using both an unstretched and a stretched technique.
OUTCOME MEASURESHeight loss after each of the three time intervals for both unstretched and stretched modes.
RESULTSThere was a clear decrease in stature during the morning, but no further loss occurred after the subjects had been up for around six hours. The mean height losses for the unstretched (stretched) modes were 0.31 cm (0.34 cm) and 0.20 cm (0.23 cm) for the periods 0900 to 1100 and 1100 to 1300, respectively, but only 0.045 cm (-0.019 cm) from 1300 to 1500. Stretching did not reduce the effects of diurnal variation, but significantly affected the recorded height by an average of 0.28 cm. There was no significant difference in reproducibility using either technique (SD 0.30 cm stretched v 0.31 cm unstretched).
CONCLUSIONSDiurnal variation in stature may substantially affect the reliability of height data and careful consideration should be given to the timing of repeat measurements. As most height loss occurs in the morning, afternoon clinic appointments would be preferable. The standard stretched technique does not appear to reduce diurnal variation, nor does it affect precision. Measurements made using an unstretched method are recommended to avoid interobserver differences, known to occur where different observers are used.

Keywords: diurnal variation; height measurement; measurement technique