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Growth monitoring: testing the new guidelines


OBJECTIVE To assess the impact of recent guidelines from the UK joint working party of child health surveillance recommending that all children be measured at age 5 and again between 7 and 9 years of age to determine how many normal school age children are likely to be referred for specialist assessment.

METHODS The longitudinal data of 486 children measured by school nurses in a community setting were examined and compared with measurements made in a research setting by a single, skilled observer.

MAIN OUTCOME MEASURES Number of children identified as having abnormal stature (< 0.4th or > 99.6th centile) and abnormal growth rate height standard deviation 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%) were identified as “slow growing”, and nine (1.9%) increased their HSDS by more than 0.67. These results were comparable to data collected in ideal research conditions.

CONCLUSIONS Following the recommendations would not result in an excess number of inappropriate referrals. However, this study highlights several unresolved issues such as interobserver variablity and time interval between measurements. A large scale prospective study should be considered to establish realistic and cost-effective criteria before implementation of a national screening programme.

  • 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

  • growth monitoring
  • height
  • growth rate
  • screening

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