Height screening at school: ineffective without high standards and adequate resources

Background: The Coventry Consensus in 1998 recommended a single height measurement of all children at school entry or around the age of 5 years and prompt referral of children with height <0.4th centile for further assessment, in order to identify undetected and treatable asymptomatic growth disorders. Aim: To determine adherence and practicalities of following the Coventry Consensus recommendations in a community setting and the cost implications. Methods: Anthropometric data of all children born between September 1992 and August 1993 in the Rhondda and Taff Ely area and measured in school year September 1998 to August 1999 were obtained from the National Child Health System (NCHS) and analysed in July 2000. Results: Only 1592 (67.6%) of 2354 eligible children had their height measured. The NCHS could only flag up height data <2nd centile. Only five of the 15 children with height <0.4th centile were. referred initially. Height measurements were not transcribed onto centiles in 75% of the case notes reviewed. When initially recalled, six of the 15 eligible children failed to attend the referral clinic. No new growth disorder was identified in any of these children. A conservative estimate of the cost to the health authority was £14 550 (US$23 300; ∈20 500) per annum. Conclusion: The study shows poor coverage and compliance together with a lack of parental awareness that short stature could be a potential health problem even in asymptomatic children. For a low yield programme to be successful and cost effective at the national level, a near 100% coverage is required. Further training of professionals in growth measurement and interpretation along with a campaign to raise both public and professional awareness is needed.