April 1st

Tam Fry

To-day sees the official publication of a paper on growth monitoring in the Archives of Disease in Childhood.  Though it has been online for some time, it is a paper that the paediatric world has been awaiting for a generation.  For the first time it concludes that growth screening is not only effective but is also cost-effective.  You might think that Government would welcome the conclusions and launch a clear growth screening policy fit for the 21stC.  Not so.   Unjoined-up thinking is its only response.
 

Not only does the March 17th Department of Health’s CHILD HEALTH PROMOTION PROGRAMME [CHPP] publication completely ignore the Archives paper and not specify a asingle growth measurement until school entry but a second DH document, HEALTHY WEIGHT, HEALTHY LIVES: GUIDANCE FOR LOCAL AREAS, published two days later, appears totally to contradict CHPP.  Published on March 19th it states that “ an important element of reducing obesity is obtaining reliable growth data “.  And if that’s not enough March’s NICE publication on MATERNAL AND INFANT NUTRITION has its own protocol for weighing babies.  It differs from either of the above two documents.  Which of these official documents are parents/medical profession supposed to follow?.

The Archives of Disease in Childhood  paper “ Effectiveness and cost-effectiveness of height-screening programme during the primary school years: a systematic review “ believes that the utility and cost-effectiveness of height screening will permit the increased detection of height-related disorders and secondary pick-up of other undiagnosed conditions.  The paper is highlighted by the Editor-in-Chief who goes so far as to state that the paper might even underestimate the diagnostic yield.  In a statement to accompany the paper’s publication Professor Gary Butler, one of the paper’s authors, calls for an urgent revision of UK growth screening “ We are failing to identify growth and obesity problems in children because we do not measure them early enough and often enough “.  The paper is also accompanied by a Perspective from Tam Fry, Honorary Chairman of the Child Growth Foundation and an NOF  Board member.  Entitled “ if it’s worth doing, let’s do it “ the Perspective pleads for the UK to have a proper height and weight monitoring protocol for the pre-school years as well as at school.

CHPP, although the DH’s January obesity strategy announcement promised that it would “ prioritise the promotion of healthy weight in early life “, not only suggests ignoring any need to take height or weight until school entry but even fails to insist on a birthweight!  NICE corrects this by stipulating that, as a minimum, babies should be weighed naked at birth, 5 days and 10 days and throughout their 1st year of life.  CHPP could be said to have got off to a very bad start and chucking the baby out with the bathwater is the first description that comes to mind.  The document CHPP endlessly qualifies growth assessment by stating that the trigger for measurement should be only a concern about growth.

On the other hand HEALTHY WEIGHT, HEALTHY LIVES: GUIDANCE TO LOCAL AREAS appears to welcome growth assessment.  In eulogising Portsmouth tPCT’s training for childhood growth and obesity assessment the document re-affirms that growth is an important indicator of health and wellbeing.  It’s bullet points list accurate measurements, plotting and interpreting growth charts, recognition of children at risk of obesity amongst its recommendations.  Clearly the author had also read the NICE advice.

NOF and the Child Growth Foundation would like to re-affirm their joint belief that the growth/BMI of all UK pre-school & school age children should be assessed annually from the age of 1yr and early interventions for either growth-related conditions or unhealthy weight gain offered.  A crude measurement though BMI may be, serial assessment is the most practical method of identifying unhealthy weight gain/loss and we should have been using it for at least the last 15yrs.  UK children – of whom 33% are overweight – did not become so overnight and our current epidemic is somewhat self-inflicted.  For the sake of children who are still infants, regular BMI checks are part of the programme aimed at ensuring that they stay a healthy weight throughout their lives.