Thank you for responding. I have been burned that way a few times.
The patient comes in at 4 years old and is on the 90% for height. Then he comes in 14 months and 18 months. At the ear infection 14 months later, he is at the 45% and at the conjunctivitis sick visit at 18 months, he is at the 35%. He had no showed for his 5 year when he would have been at the 48% and you would have been concerned about growth failure. You didn't miss anything, because you can't be expected to check heights in between visits. But you/I didn't check at the sick visits even though we got his height. So at 6 years old, you get his height and it is at the 25%.
You check his thyroid and his TSH is 500. So, when you look at the growth chart it looks like you didn't catch it until he went from the 90% to the 25%.
I don't know if the answer is to get a height and weight at every visit and always check the growth chart or to always get a weight and sometimes get a height but always check if you get a height.
The growth chart I am bringing up is an actual patient of mine. If I had checked the height at the sick visit, I would have diagnosed it then. In residency, there was this one attending who would always say, "if you aren't going to look at your vital signs, then don't get them." We could debate if a height is a vital sign but you get the idea.
I have been trying to check heights (even moreso to have my CMA check the growth chart when she puts the height in -- but you do have to go to a different page -- not a big deal, but...)
but I continue to get busy and forget to check the growth chart at Hand, Foot and Mouth visits and acne visits, etc.
