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Growth monitoring in children
1Community Medicine, Faculty of Medicine, Chiang Mai University, Aumpur Muang, Chiang Mai, Thailand, 50200. rpanpani@sd01.med.cmu.ac.th
Insights
Growth monitoring, a common pediatric practice, showed limited evidence of benefits in a review of two studies. One study found no difference in nutritional status, while another indicated improved maternal knowledge with counseling.
Area of Science:
- Pediatrics
- Public Health
- Evidence-Based Medicine
Background:
- Growth monitoring is a globally accepted pediatric service.
- It involves regular child weight recording and intervention for abnormalities.
- This review examines the evidence for its impact on child health and maternal outcomes.
Purpose of the Study:
- To evaluate the effects of routine growth monitoring on child health outcomes (mortality, morbidity, malnutrition, referrals).
- To assess the impact on maternal outcomes, including nutritional knowledge, anxiety, reassurance, and service satisfaction.
- To synthesize research evidence on the benefits and harms of growth monitoring.
Main Methods:
- Systematic review of randomized or quasi-randomized trials.
- Comparison of routine growth monitoring versus no growth monitoring.
- Studies included were conducted in developing countries.
Main Results:
- One study of 500 children found no difference in nutritional status at 30 months between groups.
- A second study reported improved maternal knowledge of growth charts after counseling.
- Limited research exists evaluating the benefits and harms of growth monitoring.
Conclusions:
- The evidence supporting the benefits of routine growth monitoring is currently limited.
- Further research is needed to understand the true impact of this widely implemented practice.
- The review highlights a surprising scarcity of data given the global investment in growth monitoring.
Editorial Note:
This review is superseded by the published Cochrane Review, Taylor 2023: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD014785.pub2/full.
Background:
Growth monitoring is widely accepted and strongly supported by health professionals, and is a standard component of community paediatric services throughout the world. We sought to evaluate research evidence of its impact. This requires definition, consideration of the setting, and discussion of the intended effects of this activity. In this review, we define growth monitoring as the regular recording of a child's weight, coupled with some specified remedial actions if the weight is abnormal in some way. Although the causes of growth faltering and the responses to it may be region specific, the process is the same, and we consider here growth monitoring in both the deprived and richer populations of the world.
Objectives:
Growth monitoring consists of routine measurements to detect abnormal growth, combined with some action when this is detected. As primary care workers worldwide invest time in this activity, we sought evidence of its benefits and harms. The review objectives are to evaluate the effects of routine growth monitoring on: 1. The child, in relation to preventing death, illness or malnutrition; and referrals for medical care, medical specialist assessment or professional social support follow-up. 2. The mother, in relation to nutritional knowledge, anxiety or reassurance about the child's health, and satisfaction with services.
Search Strategy:
Cochrane Controlled Trials Register; MEDLINE; EMBASE; CINAHL; World Health Organization and World Bank publications; specialists in this area; citations in existing reviews and identified studies.
Selection Criteria:
Randomised or quasi-randomised trials comparing routine growth monitoring (regular monitoring of growth, plotting on a chart, combined with referral or intervention when growth is abnormal) with no growth monitoring.
Data Collection And Analysis:
Trial quality was assessed, and data abstracted by both reviewers.
Main Results:
Two studies included, both conducted in developing countries. In one, the nutritional status at 30 months in 500 children showed no difference between those allocated to growth monitoring and those not. The other study examined whether counselling improved mothers' knowledge of the growth chart, and reported better test scores at four months.
Reviewer'S Conclusions:
Given the level of investment in growth monitoring worldwide, it is surprising there is so little research evaluating its potential benefits and harms.