• growth monitoring

The aim of routine growth monitoring (GM) of school age children is to identify children with the so-called “silent” conditions. These include growth hormone deficiency, hypothyroidism, and Turner’s syndrome. Using the UK 1990 nine centile growth charts it has been recommended that all children with heights less than the 0.4th centile should be referred to growth clinics for further assessment.¹ We evaluated a district GM programme fulfilling this criterion, to assess its outcome.

A total of 89.6% (3465/3864) of children in the 1999–2000 reception class (mean age 4.83 years) had their height and weight measured by school health nurses. The mean height of all the children was 108 cm with a mean height standard deviation score of 0.052; 18/3465 children (0.5%) had heights less than the 0.4th centile. Fourteen of these children have now been assessed. Table 1 shows their diagnoses.

In our programme, 50% (7/14) of children with heights less than the 0.4th centile in whom a diagnosis has been made had an organic disorder. This is a better yield than either the Wessex growth study² (which used height <3rd centile as criteria for further assessment) or the Oxford Growth study³ (which used height <2SD). The percentage of children with heights below the “cut off” that had an organic disorder in those studies were 18% and 43% respectively.

Our programme detected two children with idiopathic growth hormone deficiency (IGHD). This is more than would be expected given that the prevalence of IGHD is 1:4018.⁴ There were no children with Turner’s syndrome in our cohort. This may be because of our sample size as the prevalence of Turner’s syndrome is 1:2500 female live births.⁴ It could however be that using the 0.4th centile as referral criterion is too strict as a proportion of children with Turner’s syndrome will be taller than the 0.4th centile at this age. In the Wessex Growth study, two children identified with “silent disease” had heights above the 0.4th centile.⁵

In our programme, although a new significant diagnosis was made in 0.1% (4/3465) of the cohort, we remain concerned that the 0.4th centile “cut off” may be too strict.