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Objective: To investigate the impact of tocilizumab treatment on growth and growth-related laboratory parameters in patients with systemic juvenile idiopathic arthritis (JIA) enrolled in a phase III clinical trial., Methods: Patients with systemic JIA ages 2-17 years (n = 112) received tocilizumab in a 12-week, randomized, placebo-controlled period and a long-term open-label extension. Height velocity and standard deviation (SD) score; levels of insulin-like growth factor 1 (IGF-1), osteocalcin (OC), and C-telopeptide of type I collagen (CTX-I); and Juvenile Arthritis Disease Activity Score in 71 joints (JADAS-71) were measured in a post hoc analysis of 83 patients who never received growth hormone and did not reach Tanner stage 5 by the end of the first year of treatment., Results: Patients had stunted growth at baseline (mean height SD score -2.2). During tocilizumab treatment, males (73%) and females (83%) experienced above-normal mean height velocities of 6.6 cm/year (P < 0.0001 versus World Health Organization norms). Mean height SD score increases during year 1 (0.29) and year 2 (0.31) were significant (both P < 0.0001). The mean SD score for IGF-1 levels increased significantly (-0.2 for year 1 and -0.1 for year 2 versus -1.0 at baseline; both P < 0.0001). Mean OC and CTX-I levels (both P < 0.0001) and the OC:CTX-I ratio (P = 0.014) significantly increased from baseline to year 2. In multiple regression analysis, first-year height velocity had a significant inverse relationship to JADAS-71 at year 1, age, mean glucocorticoid dosage during the year, and height SD score at baseline., Conclusion: Our findings indicate that during treatment with tocilizumab, patients with systemic JIA experience significant catch-up growth, normalization of IGF-1 levels, and bone balance improvement favoring bone formation., (Copyright © 2015 by the American College of Rheumatology.)

Routine growth monitoring is crucial for all children. American Academy of Pediatrics guidelines state that children should be measured annually, but some children may not routinely be evaluated by primary care providers. Inpatient admissions provide the opportunity to identify growth disorders. The purpose of this study was to obtain data on the linear measuring practices in an urban children's hospital. Charts were reviewed from a random sample of 200 children who were admitted; 57% were measured, 42% had measurements plotted on growth charts, and 24% had measurements plotted correctly. Ongoing education is necessary for nursing staff to accurately obtain and plot measurements.

Introduction: Precise measurements of children are critical for accurate growth assessment. Many children are referred to endocrine practices in error because heights are obtained but plotted on length growth charts, giving the appearance that growth has decelerated., Method: In an attempt to evaluate growth assessment in primary care practices (PCPs), we instituted a telephone survey to gather the following data: (a) how often children are measured, (b) the criteria for whether children are measured standing or lying, (c) the methods for measuring children, and (d) whether measurements are plotted on growth charts and by whom., Results: In PCPs, children were reported to be measured at every visit or only at well child visits. The criteria most frequently used to determine when children should be measured standing was "if they can stand, they are measured standing." Significantly more pediatric practices than family practices measured children standing at the correct age. Heights were most often obtained on a scale with a floppy arm. All but 4 practices reported that measurements on growth charts were plotted by the nurse or physician., Discussion: Many practices had an incorrect policy related to obtaining measurements of length versus height. Children are measured with the correct equipment in only 22% of PCPs for height and 12% of PCPs for length. Most PCPs are diligent about plotting growth data. Clearly, education of personnel in PCPs is crucial so that accurate growth measurements can be obtained, necessary referrals can be made, and unnecessary referrals can be avoided.

Growth assessment is crucial in the evaluation of all children. The growth of children with chronic conditions is often inadequately assessed by subspecialty services because of the following beliefs: (1) short stature is secondary to the disorder and therefore the cause is known, (2) poor growth is caused by a syndrome and is untreatable, and (3) growth is assessed adequately by the children's primary care providers. In reality, growth failure in children with chronic conditions may be caused by other factors and may be treatable. In addition, growth is often inadequately assessed by primary health care providers. Growth abnormalities should never be ignored or minimized in populations of children having other significant health care problems.

School-aged children and adolescents bring unique problems to diabetes management. Understanding the development of these young people will help them achieve control of the diabetes.