Finds Error in Children's Growth
In a sweeping study of primary care practices
in eight U.S. cities, more than two-thirds of children were
measured incorrectly leading to possible misdiagnosis of growth
disorders, a Penn research study has found.
Reported in the current
issue of Britain’s Archives
of Disease in Childhood,
University of Pennsylvania School of Nursing Associate Professor
Terri Lipman, PhD, RN, found that heights were incorrect
by an average of 1.3 centimeters, or about one-half inch.
“Normal childhood growth is 5 cm per year
and the definition of growth failure is growth less than 4
cm per year. An inaccurate measurement of 1.3 cm could
cause the lack of detection of growth failure or the inappropriate
referral of a normally growing child,” said Dr. Lipman.
Measurements between the pediatrician’s staff and the
research staff varied by as much as 12.1 cm, four and three-fourths
Specifically, the researchers found that: Thirty
percent of children were measured correctly before training
began; only 58% of children and 18 percent of infants were
measured with accurate equipment; younger children were more
likely to be measured incorrectly; and registered nurses were
twice as likely to measure accurately.
“Some children were measured incorrectly,
wearing shoes, and infants were particularly likely to be mismeasured
by the practice of drawing pen marks on examining table paper
at the head and foot and measuring the distance in between,” Dr.
Lipman said. “However, with accurate equipment and retraining,
the average error was reduced from 1.3 cm to .5 cm (about three
sixteenths of an inch).”
The three-year $300,000 study reviewed measuring
practices of 878 children in 55 pediatric practices in eight
cities, including Philadelphia, Galveston, St. Louis, New Orleans,
Providence, Albany, Tampa Bay, and Broward County, Florida.
The study was funded by the Genentech Foundation for Growth
and Development and the Pediatric Endocrinology Nursing Society.
When obtaining height, children two years of age
and older should be measured without shoes while standing against
a wall-mounted device with a fixed right angle at the head.
Children younger than 24 months must be measured supine on
a firm platform with a yardstick attached, a fixed head plate,
and a moveable footplate with a fixed right angle.#