Technical Guide for the Early Detection of Growth and Development Disorders in Children Under 10 Years

The concepts on which the modifications to the norm 412 are proposed for the integral attention of the healthy child under 10 years, have a judicious analysis, with scientific character and strictly university criteria that recognizes the consensus of knowledge of different groups and does not possess any economic or guild interest. It reflects the healthy ambition of a health team that dreams and tends towards a better present and future for Colombian children.

These recommendations are therapeutic and diagnostic actions that are known and believed to exert a favorable influence on the evolution of patients. It is suggested to review this Guide periodically as the advances in therapeutics can modify the present recommendations and then have a temporary validity of 3 to 5 years.

Methodology

An electronic search was conducted in the Cochrane Library where the abstracts and full texts of the systematic review databases were reviewed, as well as the registry of controlled clinical experiments. In addition, a search was conducted in the National Library of the United States (MEDLINE) from 1996 to date and LILACS from its appearance until June 2005. Articles in English or Spanish were selected from journals submitted to the peer review process. Meta-analysis controlled clinical experiments, and related clinical practice guidelines were prioritized. Too, Observational studies and references suggested by experts were included in aspects in which no evidence is available since they are aspects considered as strategies of good clinical practice and are difficult to assess by means of controlled clinical experiments (ECC), since the subject to an unacceptable risk or would go against practices considered as good practices based on the usual practice of medicine. A qualitative analysis of the information weighted by the methodological quality was carried out, both of the primary sources and of the bibliographic support of reviews and consensus, to elaborate the conclusions, in degrees of it, the research was complemented with a manual search in review articles , in policy documents, National and international strategies and programs for children’s health such as IMCI and in the consensus of the Canadian task force for preventive health care. To minimize publication biases, inquiries were made with academic authorities in search of unpublished information. A qualitative analysis of the information weighted by the methodological quality was carried out, both from the primary sources and from the bibliographic support of reviews and consensus, to elaborate the conclusions, in degrees of evidence and levels of recommendation that support this update. inquiries were made with academic authorities in search of unpublished information. A qualitative analysis of the information weighted by the methodological quality was carried out, both from the primary sources and from the bibliographic support of reviews and consensus, to elaborate the conclusions, in degrees of evidence and levels of recommendation that support this update. inquiries were made with academic authorities in search of unpublished information. A qualitative analysis of the information weighted by the methodological quality was carried out, both from the primary sources and from the bibliographic support of reviews and consensus, to elaborate the conclusions, in degrees of evidence and levels of recommendation that support this update.

For this guide, the levels of evidence and grades of recommendation of the Canadian task force for preventive health care have been used (1).

2.1 Levels of evidence

  1. Evidence obtained from at least one well-designed randomized clinical experiment.
    II-1 Evidence from a clinical experiment without randomisation, well designed.
    II-2 Evidence from well-designed analytical cohort studies or cases and controls, preferably conducted in more than one center.
    II-3 Evidence of comparisons between sites and times with or without intervention.

Dramatic results from uncontrolled experiments could be included in this level.

III. Expert opinions based on clinical experience, descriptive studies or expert committee reports.

2.2 Degrees of recommendation

  1. Good evidence that supports the recommendation that the condition or maneuver should be specifically considered in a periodic health examination.
    The concepts on which the modifications to the norm 412 are proposed for the integral attention of the healthy child under 10 years, have a judicious analysis, with scientific character and strictly university criteria that recognizes the consensus of knowledge of different groups and does not possess any economic or guild interest.
    B. Little evidence supporting the recommendation that the condition or maneuver should be specifically considered in a periodic health examination.
    C. Poor evidence regarding the inclusion or exclusion of the condition or maneuver in a periodic health examination but the recommendation could be made in other scenarios.
    D. Weak evidence that the recommendation that the condition or maneuver should be specifically excluded in a periodic health examination.
    E. Good evidence that supports the recommendation that the condition or maneuver should be specifically excluded in a periodic health examination.

Throughout the document the evidence will be cited stating first the degree of recommendation and then the level of evidence, for example: grade of recommendation A, level of evidence 1: (A1).

Justification

Growth and development is the process of transformation that evolves in a dynamic and rapid way in children during their life cycle. The monitoring and accompaniment of the same, as well as the early detection and timely attention of its alterations, represents the possibility of an intervention with high social and economic profitability.

In order for this process of growth and development to take place properly, it requires that it be integral, harmonious and allows the child’s relationship with social groups, without forgetting that each human being is unique and unrepeatable and with characteristics that are proper to him and that one must respect (two) .

Accompaniment is essential to ensure strict compliance with children’s rights. Health teams should guide children, their families and communities through guidelines and standards based on scientific evidence that promote the appropriation of healthy lifestyles, healthy environments and basic health care.

The member countries of the United Nations Organization (UN) have established a global commitment to improve the quality of life, which has been recorded in the so-called millennium goals Guaranteeing children an adequate process of growth and development is one of the strategies to achieve this objective (3). Children’s health is a commitment that transcends the health sector. A nation must solve childhood problems if it wants to be successful in its struggle to achieve true development. In the first ten years many things are decided definitively for the human being. Complications in pregnancy, childbirth and preventable or easily curable diseases such as those due to lack of hygiene and an unhealthy environment can cut lives or forever limit a person’s abilities (4). The participation of government, civil society and the individual himself is required to achieve individual and collective welfare states. The modern world demands new strategies that articulate alliances to achieve greater efficiency and effectiveness in the goals set. We dream that our children are individuals with high self-esteem, autonomous, happy, supportive, healthy, creative and resilient.

Comprehensive care for all healthy children under 10 years of age, which includes the monitoring and monitoring of their growth and development process and the early detection and timely intervention of problems and risk factors, constitute a highly cost-effective action that contributes to achieve a more just and equitable society.

 

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