Growth monitoring: testing the new guidelines

doi:10.1136/adc.79.4.318

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Archives of Disease in Childhood 1998;79:318-322; doi:10.1136/adc.79.4.318

Arch Dis Child 1998;79:318-322 ( October )

J Mulligan,^a L D Voss,^a E S McCaughey,^a B J R Bailey,^b P R Betts^c

^a University Child Health, Mail Point 803, Southampton General Hospital, Southampton SO16 6YD, UK, ^b Faculty of Mathematical Studies, University of Southampton, Southampton, SO17 1BJ, UK, ^c Department of Paediatrics and Child Health, Southampton General Hospital

Correspondence to: Dr Mulligan.

Accepted 22 April 1998

OBJECTIVE $---$ To assess the impact of recent guidelines from the UK joint working party of child health surveillance recommending that allchildren be measured at age 5 and again between 7 and 9 yearsof age to determine how many normal school age children are likelyto be referred for specialistassessment.
METHODS $---$ The longitudinal data of 486 children measured by school nurses in a community setting were examined and compared with measurementsmade in a research setting by a single, skilledobserver.
MAIN OUTCOME MEASURES $---$ Number of children identified as having abnormal stature (< 0.4th or > 99.6th centile) and abnormal growth rate height standarddeviation score (HSDS) change > 0.67).
RESULTS $---$ The community survey identified seven (1.4%) children as having abnormal stature (four short, three tall), 11 (2.3%) wereidentified as "slow growing", and nine (1.9%) increased theirHSDS by more than 0.67. These results were comparable to datacollected in ideal researchconditions.
CONCLUSIONS $---$ Following the recommendations would not result in an excess number of inappropriate referrals. However, this study highlightsseveral unresolved issues such as interobserver variablity andtime interval between measurements. A large scale prospectivestudy should be considered to establish realistic and cost-effectivecriteria before implementation of a national screeningprogramme.

Key messages

Height data collected by trained community personnel will not result in an excessive number of inappropriate referrals for specialist opinion
Interobserver error will always be a problem, and consistency of measuring techniques between different observers should be a training goal
It is difficult to identify abnormal growth rate as this depends on many variables including age, height, and measurement interval
It is unusual for the height of a prepubertal school age child to change by as much as a centile channel, but such a referral criterion is unlikely to identify all growth related pathology

Keywords: growth monitoring; height; growth rate; screening

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