Fayter, D. A., Nixon, J., Hartley, S., Rithalia, A., Butler, G. E., Rudolf, M., et al. (2008). Archives of Disease in Childhood, 93, 278-284.

Growth assessment is the hallmark of pediatric screening and is recommended by the American Academy of Pediatrics as a routine aspect of pediatric healthcare, because growth failure may be the first sign of an organic illness. Some researchers argue that the number of children with growth failure is low, however, and such screening in a busy pediatric practice is not cost effective. This study was a meta-analysis of published studies reporting height assessment of children aged 4 to 11 years in Western Europe, North America, and New Zealand to determine the identification of height-related conditions.

Results showed a diagnosis of growth hormone deficiency, Turner syndrome, hypothyroidism, and other disorders at a rate ranging from 0.22 to 1.84 per 1000 children screened. Diagnosis of these conditions via height screening also led to children being diagnosed before the development of more serious symptoms and the worsening of the condition. Economic modeling indicated that height screening is cost effective.

Growth is the single most important indication of the health of a child. It is striking that financial analyses are needed to justify growth screening, but it is affirming that this meta-analysis demonstrated the importance. Pediatric nurses in all settings should incorporate ongoing, accurate growth assessment into their practice. In the United States, growth failure is defined as (a) height < the third percentile, (b) a deceleration of growth percentiles over time, or (c) growth less that 4 cm/year. In addition to being the sign of an undiagnosed disorder, growth failure can result in a child being bullied and teased. This issue should be addressed with all children who have growth disorders.

Terri H. Lipman