IT J Cole, Institute of Child Health, London, UK
© 2005 Elsevier Ltd. All rights reserved.
Growth is the single quality that most clearly distinguishes between children and adults—children grow, whereas adults do not. This in turn means that healthy children grow well and ill children often grow poorly. For this reason, the monitoring of growth is a logical and effective procedure for detecting child ill health—not just specific growth disorders but also more general conditions that affect growth indirectly.
A Cochrane Review on growth monitoring defined it as ''the regular recording of a child's weight, coupled with some specified remedial actions if the weight is abnormal in some way.'' So the key elements are one or more measurements of weight, plus a protocol for recording, plotting, and interpreting the measurements, leading in suitable cases to some intervention.
The primary purpose of growth monitoring is to detect and treat illness in the individual child. The reasonable question asked by the Cochrane Review is ''Does it work?'' The Review found only two randomised clinical trials measuring the impact of growth monitoring, and they differed in their conclusions. One found that infants whose growth was monitored for 30 months were no healthier than age-matched controls, whereas the other showed that mothers trained to use a growth chart were more knowledgeable after 4 months. So there is little research on the subject, and even less evidence to justify its use, which is surprising given the enormous resources devoted each year to growth monitoring throughout the industrialized and developing worlds.
A possible reason for this lack of evidence is that growth monitoring is seen as intrinsically 'a good thing.' Parents are always interested to know how their children are growing, and the benefit to them of measuring the child regularly, although difficult to quantify, is assumed. So there is uncertainty as to exactly what growth monitoring is for and what outcome it might lead to.
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