Assessing growth patterns--routine but sometimes overlooked

We performed a retrospective chart review for 149 randomly selected well-child encounters to evaluate the frequency with which clinicians plot growth measurements and document growth abnormalities during health maintenance visits. Providers failed to plot at least one measurement of height, weight, and/or head circumference in 31 of 149 encounters (21%, 95% CI = 14.5% to 27.5%). Growth abnormalities in size, velocity, and/or disproportion were not documented in 22 of 40 relevant encounters (55%, 95% CI = 40% to 70%). Overall, 52 of 149 encounters (35%) were associated with an unplotted measurement and/or an undocumented growth abnormality. We feel that both documentation and assessment of growth represent potential areas for quality improvement.