Clinical practice guideline on linear growth measurement of children
Jan M Foote1,2
Introduction: Growth is an important and sensitive indicator of child health. Abnormal growth is a common consequence of many conditions, therefore its identification acts as a useful warning of possible pathology. Effective growth monitoring requires precise linear growth measurements; however, measurements are often inaccurate and unreliable. Measurement error influences the interpretation of growth patterns resulting in failure to identify underlying pathology or apparent growth divergence in normally growing children.
Purpose: The purpose of this project was to develop a clinical practice guideline to assist professionals in applying evidence-based knowledge in measuring children using standardized instruments and techniques to facilitate accurate and reliable growth assessments.
Methods: Systematic methods were used to identify evidence to answer focused clinical questions about linear growth measurement. A multidisciplinary team of health professionals critically appraised and synthesized the evidence to develop explicit clinical practice recommendations using an evidence-based practice rating scheme. The guideline was prospectively evaluated through internal reviews, external expert reviews, and a pilot study.
Results: Data analyses were used to improve guideline clarity, applicability, and feasibility, while demonstrating validity and intraexaminer and interexaminer reliability (P<0.0001). The guideline provides clinical practice recommendations for measurement techniques, measurement instruments, use of less expensive instruments, calibration of instruments, diurnal height variation, measuring height versus length, replicate measurements, and special considerations. Each recommendation is linked with scientific rationale and supporting references. Tools are available to facilitate guideline implementation.
Conclusions: The clinical practice guideline on linear growth measurement is based on the best available evidence and was developed using rigorous methods. Health professionals and parents need accurate and reliable growth information. Guideline use will improve timely recognition, diagnosis, and treatment of growth disorders, while reducing unnecessary and costly evaluations in normally growing children. Widespread dissemination and adoption of the guideline can significantly impact child health around the globe.
Keywords: linear growth, children, evidence-based, clinical practice guideline.