October 5, 2001
Childhood screenings keep pace with increasing patient diversity
BY JODY McAULAY GLOOR
When it comes to childhood growth and development screening, pick the screening program that best fits your practice and -- more importantly -- your patients, Jeffrey Quinlan, M.D., said in an Assembly clinical seminar on that topic.
And those young patients are increasingly diverse, Quinlan said. The result? The latest screening information is likely to become outdated soon -- and information you learned in medical school and residency is probably obsolete. Quinlan, associate director of the family practice residency at the Naval Hospital in Jacksonville, Fla., said he decided to teach this course in order to re-educate himself on the topic.
His research turned up many answers, plus new and revised growth charts and development screenings available to today's family physician.
Older charts focused on weight for age, height for age, head circumference for age and weight for height. However, last year the Centers for Disease Control and Prevention introduced the first major revision of growth charts in more than 20 years (http://www.cdc.gov/nchs/about/major/nhanes/growthcharts/charts.htm). Weight-for-age, height-for-age and head circumference-for-age charts only were revised. But the weight-for-height chart was tossed out and replaced with one indicating body mass index for age.
Even more helpful, Quinlan said, are charts for special population groups, such as ethnic-specific charts and syndrome- or disease-specific charts. Some examples can be found at http://www.growthcharts.com/ for children with Down syndrome and http://www.adoptvietnam.org/adoption/growth-chart.htm for Asian children (with links to charts for other ethnic groups).
"Because I see military families in my practice, many of my patients are Filipino," he said. "And you can't use classic American growth charts for children who naturally may be shorter or weigh less."
What's more, today's technology has greatly increased access to these charts as well as curbed costs for them. In fact, many can be downloaded free from Web sites.
When choosing a screening tool, always consider its reliability, validity, application and appropriateness, Quinlan said. Most often in family practice, he said, "that means it's got to be quick and easy to perform. But it also needs to be relatively inexpensive." This is especially true for comprehensive screening programs.
Some tests, such as the Denver Developmental II, take at least 30 minutes to administer, yet the Denver Prescreening Questionnaire (a shorter version of DDII) takes only 5-10 minutes to complete. Ages and Stages questionnaires take about 15 minutes to administer, he said, but they now are available in languages such as Spanish, French, Mandarin, Russian and Arabic -- making them invaluable to some urban and military physicians.
Several comprehensive screens require physicians to buy expensive kits with dozens of parts, while others only require pencils, crayons and/or blocks. A little more than a year ago, Quinlan said, he was introduced to Bright Futures, a comprehensive program for children's health and development that was prepared with input from several organizations, including the AAFP.
"I've seen little knowledge of it in the medical community so far, but I highly recommend it," Quinlan said. Almost everything a physician needs for age-specific screenings can be downloaded for free from the Bright Futures Web site, which makes it a new, extremely affordable way to properly screen and diagnose young patients, he said. Go to http://www.brightfutures.org for more information on Bright Futures. *
FP Report is published by the AAFP News Department.
Copyright © 2001 by American Academy of Family Physicians.
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