Growth monitoring: testing the new guidelines

Mulligan, J., Voss, L.D., McCaughey, E.S., Bailey, B.J.R. and Betts, P.R. (1998) Growth monitoring: testing the new guidelines. Archives of Disease in Childhood, 79 (4), 318-322.

Abstract

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.

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