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ADC Fetal and Neonatal Edition Letters and ADC Education and Practice Letters
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Electronic letters published:
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Height Screening Cover Illustration
- Jerry KH Wales (2 April 2008)
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Screening for Familial Short Stature?
- Linda D Voss (22 April 2008)
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Jerry KH Wales, Senior Lecturer Paediatric Endocrinology Child Health, University of Sheffield
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j.k.wales{at}sheffield.ac.uk Jerry KH Wales
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Editor Is it any wonder that some of us doubt the value of routine height screening when an august Journal such as yours can print a cover illustration depicting terrible measurement technique and entitled Editor's choice: height screening". Your photograph shows a child looking towards the heavens (in despair, no doubt) whilst someone makes a mark on a wall vaguely above a hand-held ruler (also held at an angle). It is precisely because measurement of height and weight is often deemed "such a simple process anyone can do it, and no training is required" that one can put so little reliance on measurements obtained in screening programs that have no quality control. In "Atom" you yourself say '"a picture is worth 1000 words" - I agree. Jerry Wales |
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Linda D Voss, Senior Research Fellow Peninsula Medical School. Plymouth UK
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l.voss{at}phnt.swest.nhs.uk Linda D Voss
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Dear Editor, The purpose of screening for short stature is to pick up cases of undiagnosed pathology. I am, however, disturbed by the remark that the ‘diagnostic yield’ is potentially higher than that given in the recent systematic review (Fayter et al. 2008), partly because of a ‘growing interest in treating children with familial short stature with growth hormone’. If true, this is an extraordinary development that can only lead to a self-perpetuating demand for GH, unless, of course, we learn to manipulate the genes in order to prevent familial short stature from recurring in subsequent generations. The pharmaceutical companies need have no fear, however. Whatever advances are made, and however many we treat, there will always be a new group of ‘shortest’ children to take their place. Short stature is, after all, relative. It was not so long ago that we first heard the term ‘idiopathic short stature’, but having acquired disease status, ISS is increasingly perceived to be a legitimate target for GH therapy (Gill, 2006). The use of any quasi-diagnostic label implies underlying pathology. If FSS begins to go down the same slippery slope, moving from the purely descriptive to the pathological, there will soon be few ‘short normal’ children left (Voss 1999, 2000). References 1) Fayter D, Nixon J, Hartley S, et al. Effectiveness and cost- effectiveness of height screening programmes during the primary school years: a systematic review. Arch Dis Child 2008; 93: 278-84. 2) Gill DG. “Anything you can do, I can do bigger?": the ethics and equity of growth hormone for small normal children. Arch Dis Child. 2006 Mar;91(3):270-2. Review 3) Voss LD. Short but normal. Arch Dis Child. 1999 Oct;81(4): 370-71. 4) Voss LD. Growth hormone therapy for the short normal child: who needs it and who wants it? J Pediatr Jan 2000; 136: 103-10. |
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