Referral criteria for growth screening

Area of Science:

• Pediatrics
• Endocrinology
• Public Health

Background:

• Population height screening over 20 years reveals 17-21% of children below the third centile have organic disease.
• Disease likelihood increases to 50% for children below -3 Standard Deviations (SDs).
• Screening age impacts detection of acquired diseases and progressive growth disorders like Turner's syndrome.

Purpose of the Study:

• To evaluate the effectiveness of population height screening in identifying organic diseases in children.
• To assess the utility of height velocity and height/weight relations in improving screening sensitivity.
• To determine optimal screening protocols, including measurement frequency and referral systems.

Main Methods:

• Analysis of population height screening data spanning two decades.
• Evaluation of height velocity as a screening tool for growth disturbances.
• Assessment of height/weight relations for early detection of conditions like coeliac disease and eating disorders.
• Consideration of measurement frequency (minimum three, preferably five-six) for growth pattern definition.
• Proposal of a two-level referral system for efficient resource allocation.

Main Results:

• Significant proportion of children with short stature have underlying organic disease.
• Height velocity and height/weight relations show potential for enhanced screening sensitivity.
• Early detection of coeliac disease and eating disorders is possible with integrated screening.
• A minimum of three to six measurements are recommended for accurate growth pattern assessment.
• Referral for discrepancies greater than three centile bands between height and weight is advised.

Conclusions:

• Population height screening is crucial for detecting organic diseases and growth disturbances in children.
• Incorporating height velocity and height/weight assessments can improve early diagnosis.
• A structured, multi-level referral system optimizes resource use for managing growth issues.