Priority target conditions for algorithms for monitoring children's growth: Interdisciplinary consensus

Abstract

BackgroundGrowth monitoring of apparently healthy children aims at early detection of serious conditions through the use of both clinical expertise and algorithms that define abnormal growth. Optimization of growth monitoring requires standardization of the definition of abnormal growth, and the selection of the priority target conditions is a prerequisite of such standardization.ObjectiveTo obtain a consensus about the priority target conditions for algorithms monitoring children's growth.MethodsWe applied a formal consensus method with a modified version of the RAND/UCLA method, based on three phases (preparatory, literature review, and rating), with the participation of expert advisory groups from the relevant professional medical societies (ranging from primary care providers to hospital subspecialists) as well as parent associations. We asked experts in the pilot (n = 11), reading (n = 8) and rating (n = 60) groups to complete the list of diagnostic classification of the European Society for Paediatric Endocrinology and then to select the conditions meeting the four predefined criteria of an ideal type of priority target condition.ResultsStrong agreement was obtained for the 8 conditions selected by the experts among the 133 possible: celiac disease, Crohn disease, craniopharyngioma, juvenile nephronophthisis, Turner syndrome, growth hormone deficiency with pituitary stalk interruption syndrome, infantile cystinosis, and hypothalamic-optochiasmatic astrocytoma (in decreasing order of agreement).ConclusionThis national consensus can be used to evaluate the algorithms currently suggested for growth monitoring. The method used for this national consensus could be re-used to obtain an international consensus.

Survey highlights important discrepancies between definitions of paediatric abnormal growth taught to medical students in 23 European countries

“…A lot is at stake with regard to growth monitoring, such as the early detection of several severe conditions and an increase in referrals for nonpathological growth variations, and this is not compatible with the variations that our study detected. In addition, such variations are not compatible with the methodological standards for massive screening programmes . It is unclear why growth‐monitoring programmes do not follow international guidelines for screening tools, with identified target conditions and validated auxological parameters and thresholds to define abnormality.…”

Consensus on the principles of physical development monitoring in children, possible or not?

“…These include diseases with a natural history involving a long asymptomatic phase with predominantly anthropometric clinical expression, where early diagnosis may improve the course of the disease by reducing its severity and the risk of complications. These include coeliac disease, Crohn's disease, Turner syndrome, some forms of astrocytoma and growth hormone deficiency, craniopharyngioma, juvenile nephronophthisis, and infantile cystinosis (4) . Measurements of body height (length) are more prone to errors than those of body weight, which is due to the difficulty in measuring the youngest children (the child requires immobilisation in a certain position), lack of knowledge or ignoring of the correct measurement technique, as well as the use of inadequate anthropometric equipment.…”

Standards or References: A Central Question for Growth Monitoring?

“…Later on, its main purpose is to contribute to the timely detection of serious health conditions in order to provide optimal care and reduce morbidity and mortality . Effective growth monitoring can reduce diagnosis delays and improve prognosis for a wide range of severe conditions including growth hormone deficiency, Turner syndrome, coeliac disease, Crohn's disease, hypothalomo–optochiasmatic tumours, and chronic kidney disease . However, current tools and practices for growth monitoring are highly suboptimal, which leads to diagnostic delays for severe conditions and unnecessary referrals for disease‐free children with normal variants of growth .…”

“…This lack of standardisation is suboptimal given the individual and public health stakes of growth monitoring: earlier diagnosis and thereby improved care and prognosis of children with severe conditions as well as reduction in inappropriate referrals for disease‐free children with normal variants of growth. A recently obtained multidisciplinary consensus on priority target conditions for growth monitoring indicates a path toward this standardisation …”

“…A recently obtained multidisciplinary consensus on priority target conditions for growth monitoring indicates a path toward this standardisation. 3 About the authors B. Heude is an epidemiologist at INSERM, Paris. Her main focus is early determinants of obesity and more generally early growth and development in children.…”