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Evaluating national guidelines for monitoring early growth using routinely collected data in Bergen, Norway
Melissa R Balthasar1,2, Mathieu Roelants3, Bente Brannsether-Ellingsen1
1Department of Paediatric and Adolescent Medicine, Stavanger University Hospital, Norway.
Insights
Norwegian growth monitoring guidelines identify too many healthy children as having abnormal growth. This study suggests current guidelines need revision to better reflect normal childhood development and reduce unnecessary follow-ups.
Area of Science:
- Pediatrics
- Public Health
- Growth Monitoring
Background:
- Accurate growth monitoring is crucial for identifying developmental issues in children.
- Existing Norwegian guidelines for child growth monitoring require evaluation for effectiveness and accuracy.
Purpose of the Study:
- To assess the Norwegian guidelines for child growth monitoring using real-world data.
- To analyze growth status (size for age) and growth changes (centile crossing) in children up to five years old.
Main Methods:
- Utilized longitudinal electronic health record data from 2130 children in the Bergen Growth Study 1.
- Calculated z-scores for length, weight, weight-for-length, BMI, and head circumference.
- Compared measurements against World Health Organization (WHO) growth standards and national references.
Main Results:
- A higher proportion of children exceeded +2SD than expected, particularly for length and head circumference.
- Centile crossing was frequent in the first two years, especially for length/height.
- By age five, significant percentages required follow-up: 37.9% for length/height, 33% for head circumference, and 13.6% for high weight-for-length/BMI.
Conclusions:
- The current Norwegian growth monitoring guidelines identify an unexpectedly high number of healthy children as potentially having abnormal growth.
- Findings indicate a need to revise the guidelines to improve accuracy and reduce unnecessary interventions.
Aims:
The overarching aim of this study was to evaluate the Norwegian guidelines for growth monitoring using routinely collected data from healthy children up to five years of age. We analysed criteria for both status (size for age) and change (centile crossing) in growth.
Methods:
Longitudinal data were obtained from the electronic health record (EHR) at the well-baby clinic for 2130 children included in the Bergen growth study 1 (BGS1). Measurements of length, weight, weight-for-length, body mass index (BMI) and head circumference were converted to z-scores and compared with the World Health Organization (WHO) growth standards and the national growth reference.
Results:
Using the WHO growth standard, the proportion of children above +2SD was generally higher than the expected 2.3% for all traits at birth and for length at all ages. Crossing percentile channels was common during the first two years of life, particularly for length/height. By the age of five years, 37.9% of the children had been identified for follow-up regarding length/height, 33% for head circumference and 13.6% for high weight-for-length/BMI.
Conclusions:
The proportion of children beyond the normal limits of the charts is higher than expected, and a surprisingly large number of children were identified for rules concerning length or growth in head circumference. This suggests the need for a revision of the current guidelines for growth monitoring in Norway.
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