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JUNE 2004

Penn Research 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 inches.

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.#

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