Growth monitoring: a survey of current practices of primary care paediatricians in Europe.

Pauline Scherdel,Marie-Noëlle Robberecht-Riquet,Margareta Seher-Zupančič,Jean-François Salaün,Marilena Moretto,Gabriella Páll,Martin Chalumeau,Sigurlaug Agustsson,Laura Reali,Manuel Praena Crespo,Elke Jäger-Roman,Sanja Stanojevic

doi:10.1371/journal.pone.0070871

Abstract

ObjectiveWe aimed to study current practices in growth monitoring by European primary care paediatricians and to explore their perceived needs in this field.MethodsWe developed a cross-sectional, anonymous on-line survey and contacted primary care paediatricians listed in national directories in the 18 European countries with a confederation of primary care paediatricians. Paediatricians participated in the survey between April and September 2011.ResultsOf the 1,198 paediatricians from 11 European countries (response rate 13%) who participated, 29% used the 2006 World Health Organization Multicentre Growth Reference Study growth charts, 69% used national growth charts; 61% used software to draw growth charts and 79% did not use a formal algorithm to detect abnormal growth on growth charts. Among the 21% of paediatricians who used algorithms, many used non-algorithmic simple thresholds for height and weight and none used the algorithms published in the international literature. In all, 69% of paediatricians declared that a validated algorithm to monitor growth would be useful in daily practice. We found important between-country variations.ConclusionThe varied growth-monitoring practices declared by primary care paediatricians reveals the need for standardization and evidence-based algorithms to define abnormal growth and the development of software that would use such algorithms.

Highlights

Growth monitoring can be summarized in a five-point paradigm first described by Garner: 1) health professionals regularly measure the height and weight of children; 2) they plot the information on a growth chart; 3) when growth is abnormal, they start appropriate investigations; 4) as a result, a serious condition is diagnosed earlier; and 5) the prognosis is improved by the earlier diagnosis [1]
Because of their cross-sectional nature, growth charts provide a snapshot of population growth at only one time, with no information about centiles crossing over time [14,15]
Participants were eligible to answer the survey if they practiced primary care pediatrics in one of the 18 countries containing a European Confederation of Primary Care Paediatricians (ECPCP), a medical society of primary care paediatricians in Europe established to exchange scientific information and improve professional practice [24]

Summary

Introduction

Growth monitoring can be summarized in a five-point paradigm first described by Garner: 1) health professionals regularly measure the height and weight of children; 2) they plot the information on a growth chart; 3) when growth is abnormal, they start appropriate investigations; 4) as a result, a serious condition is diagnosed earlier; and 5) the prognosis is improved by the earlier diagnosis [1]. This simple paradigm is accepted worldwide but raises many questions: Which growth charts should be used? The introduction of the WHO growth charts, the recent availability of growth-monitoring software and the relatively recent publication of evidence-based algorithms [12,13,17,19,21,22,23] may have modified these practices

Methods

Results

Conclusion