Child Growth and Development in East London
Research type
Research Study
Full title
Child Growth and Development in East London
IRAS ID
275717
Contact name
Andrew Prendergast
Contact email
Sponsor organisation
Queen Mary University of London
Duration of Study in the UK
3 years, 0 months, 0 days
Research summary
Research Summary:
The overarching objective of this study is to detect linear growth failure (stunting) early in childhood by employing an automated growth screening algorithm for pre-school age children. The screening algorithm will be created using national data and piloted for feasibility and acceptability in Tower Hamlets, East London.We have two interlinked aims, with the following hypotheses:
Aim 1: Pilot an automated growth screening algorithm in a cohort of 630 children in east London.
Hypothesis 1: Health visitor monitoring of child height using an automated growth-screening algorithm is feasible and is acceptable to health visitors and caregivers.Hypothesis 2: Referral of children to a paediatric growth clinic has high uptake and identifies growth problems in pre-school age children.
Hypothesis 3: An additional height measurement at the child’s preschool booster immunisation appointment at their GP practice is feasible and acceptable.
Hypothesis 4: Linkage of children’s health visitor data to their height measurement as part of the NCMP is feasible and is acceptable to caregivers.
Hypothesis 5: A smartphone app is feasible and acceptable for caregivers to use to measure their children’s height at pre-school age, and there is acceptable inter-test variability between the smartphone measurement and the clinician measurement with a stadiometer
Aim 2: Generate pilot data to investigate the best indicators to detect poor school readiness and developmental problems in early childhood
Hypothesis 1: The addition of growth and development data to other environmental and socioeconomic variables (including Index of Multiple Deprivation) increases the pick-up rate of children at risk of poor school readiness and/or children with delayed development.
Hypothesis 2: There is strong correlation between the existing measurement of child development in pre-school age children (ASQ-3) and a gold standard developmental assessment by a child psychologist.
Summary of Results:
Poor linear growth can be a marker of undiscovered pathology or psychosocial vulnerability in childhood, and screening for growth may enable early detection and intervention when an underlying cause is present. However, children in the UK are not routinely or systematically screened for linear growth, even though national guidelines state that all children should have their height measured twice between the ages of 2 and 5 years. We sought to assess the feasibility of screening for growth disorders using a novel, automated growth monitoring algorithm in pre-school children. The CGEL study collected data from children attending a Healthy Child Programme (HCP) visit at age 2 years. Children were sampled from health visiting lists in an east London borough and were invited for a follow-up visit 6 to 12 months later. The standard HCP visit, which includes height and weight measurements, was completed. In addition, parental heights were obtained, and the growth screening algorithm was applied. Children with height below pre-specified thresholds, and with short height compared to their parents, were referred for further assessment at a specialist growth clinic. Three focus groups were also conducted with parents and health care providers to collect qualitative data. Feasibility of growth screening was assessed using Bowen's feasibility criteria.
The study's objectives were met and there were no safety issues. A total of 555 children with a mean age of 26 months completed the first visit, and 332 returned for a follow-up visit. The mixed methods data indicated that growth screening may be feasible, with strong evidence for acceptability, implementation, and potential efficacy, with some questions remaining around demand and practicality. Twelve study children were referred based on the results of the algorithm; four were found to have pathological short stature requiring treatment; six remained under investigation; and two were discharged after initial assessment. In conclusion, growth screening as part of the HCP at age 2 years is feasible and shows evidence for potential efficacy. The programme should now be evaluated at scale.REC name
Wales REC 4
REC reference
21/WA/0385
Date of REC Opinion
6 Dec 2021
REC opinion
Favourable Opinion