Growth monitoring: testing the new guidelines   Commentary

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 variablity and time interval between measurements. A large scale prospective study should be considered to establish realistic and cost-eVective criteria before implementation of a national screening programme. (Arch Dis Child 1998;79:318-322)

Survey of parents, nurses, and school principals on their perceptions of the controversial role of schools in health promotion

“…However, these would almost certainly come at the cost of some of the routine health surveillance practices performed today, because of the shift in greater investment in health promotion and counseling, including additional ad hoc nursing time and an upgrade of nursing education curriculum and programs to include the evaluation of children with social or scholastic problems 14 . This practice is in line with recent studies that have raised concerns over the health value and cost‐effectiveness of routine health examinations and health care interviews, as administered in England after 5 years of age 6,15,16 . Several researchers reported that although parents may find these examinations reassuring, most know little about the school health service in general, or even the name of the physician or nurses at their child's school 17 .…”

Growth monitoring

“…Around one sixth of patients with Turner's syndrome and one third of patients with GHD with height above −2.5 SD (close to the UK 0.4th centile) might be identified by measuring three year height gain between 5 and 12 years of age 35. Specificity is also a problem—in one community study, 2% of all children crossed one centile band downwards between 5 and 8 years of age23 (and 2% crossed one band upwards). For infants and preschool children, the measurement error is greater, and both sensitivity and specificity are worse 35…”

Towards evidence based referral criteria for growth monitoring

“…The current state of affairs unfortunately precludes an informed discussion about referral criteria. Referral criteria have been evaluated, [3][4][5][6][7] but these studies have not prevented the appearance of widely different guidelines. For example, the recent UK guideline is based on just one universal height measurement at age 5.…”