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Re: Height screening at school

Dear Editor

We applaud the honesty of Banerjee et al. in reporting on their review of community height screening. They found that the quality of measurement was poor but perhaps this is not surprising, since there seems to have been little investment in training or quality monitoring. We wish to make two points in reply to the commentary by Betts.

Firstly, we emphasise that the reason we have questioned the value of whole-population growth monitoring [1] is not that measuring is often badly done. Technique could undoubtedly be improved. It is rather that when analysed as a screening process, the maximum potential yield, sensitivity and specificity of growth monitoring are disappointing, even when carried out to a high standard.

Second, we have looked in detail at the question of obtaining mid- parental height to improve the performance of growth screening in the community. We concluded that the judgements that have to be made require a degree of sophistication that belongs, for the present, in a specialist clinic, not in whole population screening programmes. Indeed, the value of target height in detecting 'hidden' pathology was recently examined in a cohort of short children and its usefulness called into question.[2]

The essential ingredients for early recognition of abnormal growth are a knowledge of how to assess growth as part of routine paediatric consultation in primary care, a readiness to listen to parental worries and quick, easy referral to specialist services when in doubt. Current evidence suggests that the additional yield of a whole-population growth screening programme would be modest and that a high price would be paid in false positives.

David Elliman
Consultant in Community Child Health, Islington PCT and Great Ormond Street Hospital

David Hall
Professor of community paediatrics, Sheffield

Linda D Voss PhD
Peninsula Medical School, Plymouth Campus

References

(1) Hall DMB and Elliman D (Eds) Health For All Children. 4th edition. Oxford: OUP; 2003.

(2) Mulligan J and Voss LD, Non-familial short stature. Arch Dis Child 2000;83:369