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Assessment of growth by primary health care providers
T H Lipman1, K Hench, J D Logan
1University of Pennsylvania School of Nursing, 420 Guardian Dr, Philadelphia, PA 19104, USA.
Insights
Accurate child growth assessment requires correct height and length measurements. Many primary care practices (PCPs) use improper techniques, leading to inaccurate growth plotting and unnecessary referrals.
Area of Science:
- Pediatrics
- Growth Monitoring
- Healthcare Quality
Background:
- Accurate measurement of children is essential for proper growth assessment.
- Inaccurate height measurements plotted on length charts can lead to erroneous conclusions about growth deceleration.
Purpose of the Study:
- To evaluate current growth assessment practices in primary care settings.
- To identify common errors in pediatric measurement techniques and data plotting.
Main Methods:
- A telephone survey was conducted in primary care practices (PCPs).
- Data collected included measurement frequency, criteria for standing vs. recumbent measures, measurement methods, and plotting procedures.
Main Results:
- Practices varied in measurement frequency and criteria for standing measurements.
- Incorrect equipment and methods for height and length measurements were common.
- Most PCPs accurately plotted growth data, but initial measurements were often flawed.
Conclusions:
- Significant deficiencies exist in obtaining accurate pediatric measurements in PCPs.
- Educational interventions are needed to improve measurement techniques and reduce unnecessary referrals.
- Correcting measurement protocols can enhance the accuracy of growth assessment.
Introduction:
Precise measurements of children are critical for accurate growth assessment. Many children are referred to endocrine practices in error because heights are obtained but plotted on length growth charts, giving the appearance that growth has decelerated.
Method:
In an attempt to evaluate growth assessment in primary care practices (PCPs), we instituted a telephone survey to gather the following data: (a) how often children are measured, (b) the criteria for whether children are measured standing or lying, (c) the methods for measuring children, and (d) whether measurements are plotted on growth charts and by whom.
Results:
In PCPs, children were reported to be measured at every visit or only at well child visits. The criteria most frequently used to determine when children should be measured standing was "if they can stand, they are measured standing." Significantly more pediatric practices than family practices measured children standing at the correct age. Heights were most often obtained on a scale with a floppy arm. All but 4 practices reported that measurements on growth charts were plotted by the nurse or physician.
Discussion:
Many practices had an incorrect policy related to obtaining measurements of length versus height. Children are measured with the correct equipment in only 22% of PCPs for height and 12% of PCPs for length. Most PCPs are diligent about plotting growth data. Clearly, education of personnel in PCPs is crucial so that accurate growth measurements can be obtained, necessary referrals can be made, and unnecessary referrals can be avoided.