Referral criteria for growth screening.

Population height screening studies performed over the past 20 years have shown that between 17 and 21% of children with heights below the third centile have organic disease, of whom about 20% will be new diagnoses. The likelihood of organic disease increases to 50% for children with heights below -3 SDs. The age of screening will also influence the outcome as both acquired disease and disorders with progressive growth slowing, such as Turner's syndrome, are more likely to be detected by screening at an older age. Height velocity as a screening tool has evoked interest for many years as, despite technical problems, slowly growing children are thought more likely to have disease. Inclusion of height or height/weight relations may further improve screening sensitivity. It may assist in the early detection of coeliac disease or eating disorders in older children. A minimum of three measurements is required to define an individual's growth pattern and, preferably, five or six measurements spread over the preschool and primary school years. The value of extension of growth screening to the secondary school age group remains uncertain. Children should be screened for both height and weight and referred when there are major discrepancies between these two measurements (more than three centile bands). A two level system of referral with a community assessment for some children and a direct referral to a growth clinic for children with more severe growth disturbance may be the best use of resources.