Aim To develop a guideline for preventive child healthcare professionals in order to improve early detection of pathological disorders associated with short stature (or growth faltering) or tall stature (or accelerated growth). Methods We updated the previous Dutch guideline for short stature in children aged 0‐9 years and extended it to adolescents (10‐17 years), and added a guideline for tall stature, based on literature and input from an expert committee. Specificities were calculated in a cohort of healthy Dutch children aged 0‐9 years (n = 970). We investigated the impact of a late onset of puberty on height standard deviation score based on the Dutch growth charts. Results Growth parameters of the guideline include height, the distance between height and target height and change of height over time. Other parameters include diagnostic clues from medical history and physical examination, for example behavioural problems, precocious or delayed puberty, body disproportion and dysmorphic features. Conclusion Preventive child healthcare professionals now have an updated guideline for referring short or tall children to specialist care. Further research is needed on the diagnostic yield after referral and specificity at field level.

Background Clinical guidelines are important for providing high-quality child primary health care. We aimed to assess the availability, use and achieved delivery of guidelines in the European Union (EU). Methods We used a case study design to ascertain expert views on guidelines in six countries representing the EU. The experts completed an online questionnaire (response 49%), asking about their perception of guideline availability and implementation regarding three topics that represent prevention and care, i.e. vaccination, assessment of mental health and asthma care. Results According to the respondents all countries had guidelines available for asthma care. For vaccination and mental health assessment respondents agreed to a lesser degree that guidelines were available. Implementation of guidelines for vaccination was mostly perceived as intended, but implementation of the guidelines for mental health assessment and asthma care was limited. Notable barriers were complexity of performance, and lack of training of professionals and of financial resources. Important facilitators for guideline implementation were the fit with routine practice, knowledge and skills of professionals and policy support. We found no clear relationship of guideline availability and implementation with type of child primary health care system of countries, but strong governance and sufficient financial resources seemed important for guideline availability. Conclusions Availability and implementation of clinical guidelines in child primary health care vary between EU countries. Implementation conditions can be strongly improved by adequate training of professionals, stronger governance and sufficient financial resources as facilitating factors. This can yield major gains in child health across Europe.

Het doel van dit onderzoek was het ontwikkelen van een richtlijn voor Jeugdgezondheidszorg (JGZ)-professionals om aandoeningen die samenhangen met een kleine lengte (en/of trage groei) of een grote lengte (en/of snelle groei) vroegtijdig op te sporen. Methode: Op basis van literatuur en advies van een expertcommissie werd de vorige JGZ-richtlijn Signalering van en verwijscriteria bij kleine lichaamslengte voor kinderen van 0 tot 10 jaar geactualiseerd en uitgebreid naar adolescenten (10 tot 18 jaar). Verder werden verwijscriteria voor grote lengte toegevoegd. De specificiteit van nieuwe verwijscriteria werd berekend in een cohort van gezonde Nederlandse kinderen van 0 tot 10 jaar (n = 970). Daarnaast werd de invloed van een late puberteit op de standaarddeviatiescore (SDS) voor lengte op basis van de Nederlandse groeidiagrammen onderzocht. Resultaten: Groeiparameters van de richtlijn zijn:(1) lengte, (2) de afstand tussen lengte en de streeflengte (target height) en (3) een groeiafbuiging of -toename in SDS. Andere parameters zijn aanwijzingen uit de anamnese en het lichamelijk onderzoek, Dit artikel is een bewerkte vertaling van: Dommelen P van, Zoonen R van, Vlasblom E, Wit JM, Beltman M; the Expert Committee. Guideline for referring short or tall children in preventive child health care. Acta Paediatr. 2021;110:1231-8. De figuren zijn afkomstig van de JGZ-richtlijn Lengtegroei (2019; www.jgzrichtlijn.nl).

There is considerable heterogeneity between primary care systems that have evolved in individual national cultural environments. Models of Child Health Appraised (MOCHA) studied how the transfer of models or their individual components can be achieved across nations, using examples of combinations of settings, functions, target groups and tracer conditions. There are many factors that determine the feasibility of successful transfer of these from one setting to another, which must be recognised and taken into account. These include the environment of the care system, national policy-making and contextual means of directing population behaviour À in the form of penalties and incentives, which cannot be assessed or expected to work by means of rational actions alone. MOCHA developed a list of criteria to assess transferability, summarised in a population characteristics, intervention content, environment and transfer (PIET-T) process. To explore the process and means of transferability, we obtained consensus statements from the researchers on optimum model scenarios and conducted a survey of stakeholders, professionals and users of children's primary care services that involved three specific health topics: vaccination coverage in infants, monitoring of a chronic or complex condition and early recognition of mental health problems. The results give insight into features of transferability À such as the availability and the use of guidelines and formal procedures; the barriers and facilitators of implementation and similarities and differences between model practices and the existing model of child primary care in the country. We found that

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