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Improving the understanding, recognition, and outcomes of linear growth faltering in pre-school children

Code: BC-DTP_2026_07
Title: Improving the understanding, recognition, and outcomes of linear growth faltering in pre-school children

Primary Supervisor: Andrew Prendergast
Email: a.prendergast@qmul.ac.uk
Institute: Blizard Institute

Secondary Supervisor: Helen Storr
Email: h.l.storr@qmul.ac.uk 
Institute: William Harvey Research Institute 

Lay Summary:

Height is an excellent marker of child health and wellbeing. Growth failure/short stature (SS) can indicate serious treatable medical problems but can also reflect adversity in a child’s environment. SS is important because it predicts school achievement, and future opportunity into adulthood. We have shown that SS is concentrated in poorer regions of England, with east London a particular ‘hot spot’ – suggesting an unmet need in helping children to thrive in deprived communities. 

Height is measured by health visitors (HV) at 2-2.5 year checks, and at school entry (age 4-5 years) but is not routinely acted upon. Therefore, there are missed opportunities for early identification and intervention for children with SS. We have developed an ‘algorithm’ which allows HV to input child/parent heights into a computer and flag those needing referral for SS. This approach could identify children with underlying medical or social needs, and allow early intervention. 

This PhD project will validate the algorithm (which uses child’s height-for-age, distance to parental height, and growth rate) to accurately flag two groups of children with SS: those needing investigation for suspected medical problems and those requiring social support. Second, this project will establish potential social interventions (such as early child development services, benefits advice, or parenting advice). Finally, the project will map and pilot referral pathways for children in east London requiring medical and social interventions.

This work aims to identify children with underlying medical or social needs, and intervene to improve health, growth, school attainment, and life chances. 

Aims and Objectives:

Aim To improve the detection of linear growth faltering in pre-school children to enable early referral and management of underlying medical and social problems.

Objectives

  • Engage patients, carers, service providers and the public to shape and influence the proposed work to ensure relevance, quality, and impact.
  • Optimise the sensitivity and specificity of our growth monitoring algorithm and therefore its ability to identify children with medical and social problems requiring referral and investigation.
  • Identify and map appropriate, locally available child support services.
  • Establish referral pathways for children requiring medical and social interventions due to poor growth and develop intervention strategies.

References:

  1. Freer J, Orr J, Walton R, Storr HL, Dunkel L, Prendergast AJ. Does stunting still matter in high-income countries? Ann Hum Biol. 2023;50(1):267-273.
  2. https://publications.parliament.uk/pa/cm201719/cmselect/cmhealth/882/882.pdf
  3. https://stateofchildhealth.rcpch.ac.uk
  4. Orr J, Freer J, Morris JK, et al. Regional differences in short stature in England between 2006 and 2019: A cross-sectional analysis from the National Child Measurement Programme. PLoS Med. 2021;18(9):e1003760.
  5. https://cls.ucl.ac.uk/cls-studies/millennium-cohort-study/
  6. Freer J, Orr J, Morris JK, et al. Short stature and language development in the United Kingdom: a longitudinal analysis of children from the Millennium Cohort Study. BMC Med. 2022;20(1):468.
  7. http://www.borninbradford.nhs.uk/
  8. Orr J, Cordani I, Daya N, et al. Embedding a novel growth monitoring algorithm in the UK Healthy Child Programme: A mixed methods feasibility study. BMC Public Health. 2025;Under revision.
  9. https://cprd.com
  10. Savage MO, Backeljauw PF, Calzada R, et al. Early Detection, Referral, Investigation, and Diagnosis of Children with Growth Disorders. Horm Res Paediatr. 2016;85(5):325-332.
  11. Maghnie M, Ranke MB, Geffner ME, et al. Safety and Efficacy of Pediatric Growth Hormone Therapy: Results From the Full KIGS Cohort. J Clin Endocrinol Metab. 2022;107(12):3287-3301.
  12. Wyatt D. Lessons from the national cooperative growth study. Eur J Endocrinol. 2004;151 Suppl 1:S55-59.
  13. Shepherd S, Saraff V, Shaw N, Banerjee I, Patel L. The BSPED National Growth Hormone (GH) Audit: Trends in Prescribing from 2013–2016. Paper presented at: 57th European Society of Paediatric Endocrinology (ESPE) Meeting2018; Athens.
  14. https://assets.publishing.service.gov.uk/media/5a80a5bb40f0b62305b8c59e/School_readiness_10_Sep_15.pdf
  15. https://www.babinetwork.co.uk
  16. https://www.england.nhs.uk/about/equality/equality-hub/national-healthcare-inequalities-improvement-programme/core20plus5/core20plus5-cyp/
  17. https://www.england.nhs.uk/long-term-plan/
  18. Davies JH, Child J, Freer J, Storr HL. Inequalities in the assessment of childhood short stature. Br J Gen Pract. 2023;73(729):150-151.



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