Lipman T. H., Hench, K. D., Benyi, T., Delaune, J., Gilluly, K., Johnson, L, et al. (2004).Archives of Disease in Childhood, 89, 342-343.

Growth is the single most important indication of the health of a child, and growth assessment is non-intrusive, inexpensive, and easily understood. This study was designed to determine the accuracy of linear growth assessment in primary care practices (PCP) in eight cities in the United States and evaluate the effect of an intervention to improve the accuracy.

Pediatric endocrine nurses as site coordinators (SC) visited 55 randomly assigned PCP to evaluate growth assessment of staff performing measurements. SC observed 127 staff measuring a total of 878 children. State-of-the-art equipment and a standardized growth training session were provided to the intervention group immediately following the baseline visit. SC repeated data collection at 3 months and 6 months. At baseline, only 30% of measurements were accurate. Measurements differed by as much as 12.1 cm from SC, with an average difference of 1.3 cm. After the intervention, significantly more measurements were accurate in the intervention group; 55% at 3 months and 70% at 6 months. There was no improvement in accuracy in the control group.

This study confirms what many healthcare providers and parents know. In PCP, children are often measured with inaccurate equipment and incorrect technique, yielding inaccurate measurements. So what if a child is measured incorrectly by 1.3 cm? Does it really matter? It certainly does!! The average child grows 5 cm/y. Growth failure can be the first sign of an organic disease such as hypothyroidism or celiac disease. An error of 1.3 cm could cause the lack of diagnosis of a growth disorder or the inappropriate referral of a normally growing child. Why were children measured so inaccurately in this study? Errors in technique included children measured wearing shoes or standing with feet splayed. Much of the "equipment" used to measure children (a floppy arm on a balance scale, marking the exam table paper to measure a baby) is inherently inaccurate. Pediatric nurses must insist that accurate equipment be available to measure children, and the nurses must be knowledgeable about correct measurement technique. This simple, non-intrusive assessment is a major component of pediatric nursing care.

Comment by Terri H. Lipman