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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 hav...
Firstly, we emphasise that the reason we have questioned the value of
whole-population growth monitoring  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.
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
Consultant in Community Child Health, Islington PCT and Great
Ormond Street Hospital
Professor of community paediatrics, Sheffield
Linda D Voss PhD
Peninsula Medical School, Plymouth Campus
(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