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 It may seem simple in theory to look at how children’s height and
weight compare to that of other kids their age and then search for
medical reasons why some of them might, for example, be unusually
short.
But first, doctors need to agree on what constitutes abnormal growth
– and they don’t – researchers note in their January 14 online paper
in The Lancet Diabetes and Endocrinology.
“Growth-monitoring is widely used in most countries in the world,”
lead researcher Pauline Scherdel of INSERM in Paris said by email.
“However, we have found strong empirical evidence showing that the
current practices are suboptimal – diagnostic delays in one hand and
unnecessary diagnostic work-up in the other hand.”
Researchers examined 69 previously published studies, which compared
the performance of growth charts from the World Health Organization
(WHO) to other growth charts and looked at seven different
algorithms for defining abnormal growth that have been proposed in
the past 20 years.
They also explored which conditions might be spotted by monitoring
growth charts and how abnormal development should be defined.
While dozens of diseases may be potential causes of abnormal growth,
researchers found most previous research focused on six conditions:
Turner syndrome, celiac disease, cystic fibrosis, growth hormone
deficiency, renal tubular acidosis and small for gestational age
with no catch-up after two or three years.
Even though there was some consensus that these diseases are among
the ones that should be considered when kids don't grow like their
peers, the analysis found little evidence that the seven algorithms
used to define abnormal growth proposed in earlier studies were
effective.
Two studies reported that WHO growth charts had poorer performance
compared with other existing growth charts for early detection of
target conditions.
One study from the Netherlands found as many as 95% of referrals for
tests to detect problems based on abnormal growth didn't turn up
anything, suggesting there were unnecessary screenings being done in
healthy children, the authors conclude.
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Two clinical decision tools – the Grote and Saari methods – appeared
to be the most promising of the bunch because they were highly
specific in detecting Turner syndrome and celiac disease, the
authors concluded. The Grote clinical decision rule also appeared
specific enough to detect cystic fibrosis.
Among other things, the Grote and Saari methods both relied on
observation of standardized height, distance to standardized target
height, and height deflection (a reduced growth rate indicated by
adjusted height over time).
Limitations of the study include its reliance on published studies,
which may not accurately reflect what doctors do in day-to-day
practice to track how children grow, the authors note.
Finding the best way to use growth as an early warning for childhood
disease is important because this has the potential to be a low-cost
and simple way to identify kids who may have health problems that
are negatively impacting their development, Dr. Jana Vignerova, a
researcher at the National Institute of Public Health in Prague who
wasn't involved in the study, said by email.
"Growth charts are a single, cheap and non-invasive tool, Vignerova
said. "Other methods are more expensive and mostly invasive, such as
blood tests, X-rays and other examinations."
SOURCE: http://bit.ly/1QWwdlF
Lancet Diabetes Endocrinol 2016.
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