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Growth monitoring: testing the new guidelines
J Mulligan1, L D Voss, E S McCaughey
1University Child Health, Southampton General Hospital, UK.
Insights
Recent UK guidelines for child health surveillance suggest routine measurements at ages 5 and 7-9. This study found these guidelines would not lead to excessive referrals for children with abnormal stature or growth rates.
Area of Science:
- Pediatric endocrinology
- Growth monitoring
- Public health surveillance
Background:
- Recent UK guidelines recommend child measurements at ages 5 and 7-9 years.
- The impact on specialist referral rates for normal school-aged children is unclear.
Purpose of the Study:
- To assess the impact of new UK child health surveillance guidelines on specialist referrals.
- To determine the number of normal school-aged children likely to be referred.
Main Methods:
- Longitudinal data from 486 children measured by school nurses were analyzed.
- Community measurements were compared to those from a research setting.
- Abnormal stature (<0.4th or >99.6th centile) and growth rate (HSDS change >0.67) were assessed.
Main Results:
- The community survey identified 1.4% with abnormal stature and 2.3% as slow growing.
- 1.9% showed a height standard deviation score (HSDS) change >0.67.
- Results were comparable to ideal research conditions.
Conclusions:
- Implementing the guidelines is unlikely to cause excessive inappropriate referrals.
- Issues like interobserver variability and measurement intervals require further investigation.
- A large prospective study is needed to establish cost-effective screening criteria.
Objective:
To assess the impact of recent guidelines from the UK joint working party of child health surveillance recommending that all children be measured at age 5 and again between 7 and 9 years of age to determine how many normal school age children are likely to be referred for specialist assessment.
Methods:
The longitudinal data of 486 children measured by school nurses in a community setting were examined and compared with measurements made in a research setting by a single, skilled observer.
Main Outcome Measures:
Number of children identified as having abnormal stature (< 0.4th or > 99.6th centile) and abnormal growth rate height standard deviation score (HSDS) change > 0.67).
Results:
The community survey identified seven (1.4%) children as having abnormal stature (four short, three tall), 11 (2.3%) were identified as "slow growing", and nine (1.9%) increased their HSDS by more than 0.67. These results were comparable to data collected in ideal research conditions.
Conclusions:
Following the recommendations would not result in an excess number of inappropriate referrals. However, this study highlights several unresolved issues such as interobserver variability and time interval between measurements. A large scale prospective study should be considered to establish realistic and cost-effective criteria before implementation of a national screening programme.