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Table 1 Auxological referral criteria taken from the Dutch Consensus Guideline [3]

From: Referral patterns of children with poor growth in primary health care

Description rule   Criteria Rule nr.
Absolute height   HSDS* < -2.5 (P0.6) 1
Clinical symptoms   HSDS* < -1.3 (P10) AND (dysmorphic features OR disproportions) 2
Persistent short stature after born SGA**   SGA** AND HSDS* < -1.88 (P3) after the age of 2 years 3
HSDScor ♂: < 10 yr and > 13.4 yr; HSDS* < -1.3 AND HSDS-THSDS < -1.3 4
  ♀: < 9 yr and > 12.3 yr   
  Pubertal age: HSDS* < -1.3 AND HSDS-THSDS§ < -1.3 AND pubertal signs 5
  ♂: 10 – 13.4 yr;   
  ♀: 9 – 12.3 yr   
Deflection ♂: < 10 yr and > 13.4 yr; T2 – T1 > 1 6a
  ♀: < 9 yr and > 12.3 yr (SDS1 – SDS2)/(T2-T1) < -0.25  
   T2 – T1 > 1 6b
   (SDS1 – SDS2) < -1  
  Pubertal age: T2 – T1 > 1 7a
  ♂: 10 – 13.4 yr; (SDS1 – SDS2)/(T2-T1) < -0.25  
  ♀: 9 – 12.3 yr With pubertal signs  
   T2 – T1 > 1 7b
   (SDS1 – SDS2) < -1  
   With pubertal signs  
  1. * HSDS = Height Standard Deviation Score
  2. **SGA = Small for Gestational Age
  3. § THSDS = Target Height Standard Deviation Score
  4. HSDScor = HSDS corrected for parental height
  5. Deflection: Deflection is divided into a deflection per time interval (6a and 7a) and an absolute deflection (7b) The deflection per time interval represents a downward movement of HSDS (HSDS2-HSDS1) over time (T2-T1), while the absolute deflection is defined by a decrease of HSDS over an unspecified time period. In the categories 3–10 and 10–18, T1 > = 3 years, in the other categories T1 > 0.
  6. Pubertal age: If a child does not show any pubertal signs (♂: genitals > = Tanner stage 2 OR testis volume > = 4 ml; ♀: breast > = Tanner stage 2) at this age referral is not necessary.