• height monitoring
• diagnosis
• growth

Measurement of height is an important component of child health care and has been widely incorporated into paediatric practice. Yet little is known about how it performs in terms of sensitivity and specificity for detecting growth disorders. This lack of information impacts on health care in a number of ways. First, it is difficult to inform public health policy via recommendations for height monitoring, which has resulted in a plethora of statements made about referral for height assessment. One consequence of this has been to opt for a minimum standard for practice as exemplified in Health for all children.¹ Second, the lack of information on test performance in the early steps of the short stature evaluation decision tree makes it difficult to interpret subsequent tests and ultimately the likelihood of the presence or absence of disease.²

The Dutch study reported by van Buuren and colleagues in this issue³ addresses for the first time these issues of test performance by quantifying the role of height monitoring in the identification of girls with Turner’s syndrome (TS). TS is the ideal condition to use to show the methodology as it fulfils several important screening criteria—it is common (1 in 2500 live female births), a confirmatory test is available with high sensitivity …