Evidence-based guidelines for growth monitoring

Abstract

Guidelines for growth monitoring can be established according to two approaches. According to the clinical approach, health workers are expected to base their assessment on the cumulative information from the medical history, physical examination and growth against a background of knowledge about the possible causes. The second approach is that of public health, where growth monitoring is considered as a screening programme. Three consensus-based and one evidence-based guidelines for referral of short children are discussed. The evidence-based guideline is based on an analysis of growth patterns of children with growth disorders and of healthy children. Height SDS (in comparison to an appropriate age reference), height SDS in comparison to sex-corrected mid-parental height (target height) SDS and the change of height SDS over time were analysed. This guideline results in a sensitivity of approximately 80% at a false-positive rate of 2%. With respect to failure to thrive in infants and young toddlers, monitoring for length has a low predictive value for detecting pathological causes. The diagnostic properties of weight-for-age or body mass index are better, but still their predictive value is modest to detect celiac disease, cystic fibrosis and renal tubular acidosis. We propose that algorithms based on the evidence-based guideline for growth monitoring should be incorporated into electronic databases of growth data in child health programmes.