# Child Metrics (ÇEDD Çözüm)
# https://childmetrics.org | https://ceddcozum.com

## About
Child Metrics is a freely accessible online clinical calculator platform for pediatricians, with particular depth in pediatric endocrinology. Developed in partnership with the Turkish Society for Pediatric Endocrinology and Diabetes (ÇEDD). All calculations run client-side; no patient data is transmitted or stored.

## Publications
- Demir K, et al. A comprehensive online calculator for pediatric endocrinologists: ÇEDD Çözüm/TPEDS Metrics. J Clin Res Pediatr Endocrinol. 2017;9(2):182-184. doi:10.4274/jcrpe.4526
- Demir K, et al. New features for Child Metrics: Further growth references and blood pressure calculations. J Clin Res Pediatr Endocrinol. 2019;12(2):125-129. doi:10.4274/jcrpe.galenos.2019.2019.0127

## Available Calculators (33 tools)

### Growth
- Auxology: Height, weight, BMI, head circumference SDS using CDC, WHO, Neyzi references. Supports 13 syndrome-specific conditions (Down, Turner, Noonan, Prader-Willi, Achondroplasia, Hypochondroplasia, Silver-Russell, Marfan, Williams, Osteogenesis Imperfecta [Types I/III/IV; ±2 SD display only — ±3 SD lines omitted due to extreme LMS parameters at infant ages], XLH, Mucopolysaccharidosis [MPS II Hunter, MPS IVA Morquio A, MPS VI Maroteaux-Lamy], Klinefelter syndrome [47,XXY]).
- Height Velocity: Growth rate SDS using Kelly, Baumgartner, Neyzi, WHO, Tanner datasets.
- Longitudinal: Serial growth charting for one patient over time — multi-visit table with per-visit SDS and interval growth velocity plotted on the growth chart.
- CNP Analogue Dosing: Vosoritide (daily µg/kg) and navepegritide (weekly) dose calculators for achondroplasia.
- Predicted Adult Height: Bayley-Pinneau and Roche-Wainer-Thissen methods.
- Growth Hormone Dose: rhGH dose calculator with bidirectional prescribe/analyze modes. Supports daily and weekly (somatrogon) dosing.
- IGF-1 & IGFBP-3 SDS: Güven, Elmlinger, Roche Elecsys references.
- LAGH IGF Correction: Adjusts IGF-1 SDS for long-acting growth hormone preparations.
- Body Ratios: Upper/lower segment ratio, sitting height, arm span, waist circumference, Binder index. Standard and syndrome-specific references.

### Neonatal
- Neonatal Parameters: Birth weight, length, head circumference SDS using Kurtoglu (term) and Fenton 2025 (preterm) references.
- Corrected Age: Gestational age adjustment for preterm infants.

### Bone & Mineral
- BMD SDS: Bone mineral density Z-scores using Gökşen (L1-L4) and de Groot (TBLH) references.
- Corrected BMD: Volumetric BMD correction using Katzman-Carter formula.
- Elemental Calcium: Bidirectional conversion between elemental calcium and preparation doses.
- Tubular Function: TRP, TmP/GFR, CCCR calculations.
- Phosphorus SDS: Serum phosphorus Z-scores from HARP cohort.
- sKlotho SDS: Soluble Klotho level reference from HARP cohort.

### Diabetes
- HbA1c Converter: Interconverts HbA1c, estimated average glucose, and fructosamine.
- Insulin/C-Peptide Ratio: Molar ratio for insulin source assessment.
- Insulin Resistance: HOMA-IR, QUICKI, glucose/insulin ratio.

### Adrenal
- Steroid Conversion: Glucocorticoid equipotency calculator.

### Organ Size
- Testicular Volume: Ultrasonography, orchidometer, ruler references (Koskela 2024).
- Penile Anthropometry: Stretched penile length and circumference SDS (Cinaz 2011).
- Pituitary Height: MRI-based pituitary height SDS (Sarı 2014).
- Thyroid Volume: Multiple references (Aydıner, Rossi, Kurtoglu, Mutlu, Tuzcu).
- Uterus & Ovary Volume: SDS using Gilligan and Herter references.
- hCG Test: T/DHT and T/androstenedione ratios.

### Blood Pressure
- Office Blood Pressure: Percentiles using Rosner 2008 quantile regression (AAP 2017 guidelines).
- ABPM: 24-hour ambulatory blood pressure SDS using Wühl 2002.

### Utilities
- Corrected Sodium: Hyperglycemia correction using Katz formula.
- Osmolality: Serum and urine osmolality calculator.
- Body Surface Area: Costeff, Mosteller, Du Bois, Haycock formulas.
- Unit Converter: Common laboratory unit conversions.

## Computational Methods
- LMS method for SDS calculation (Cole & Green)
- WHO SD23 correction for extreme z-scores
- Quantile regression for blood pressure (Rosner 2008)
- No extrapolation beyond validated dataset boundaries

## Reference Datasets
85 integrated reference datasets covering standard growth (CDC, WHO, Neyzi), 29 syndrome-specific growth charts across 13 conditions, neonatal references, organ volumes, blood pressure, bone density, IGF, height velocity, body ratios, and other parameters. Full dataset metadata (population, sample size, age range, statistical method) available within each tool.

## CLI & npm Package

Child Metrics is available as a command-line tool for programmatic access to all 33 calculators. No API keys, no network requests — everything runs locally.

### Installation
```
npx childmetrics            # run directly
npm install -g childmetrics # or install globally
```

Also published as `ceddcozum` (alias):
```
npx ceddcozum auxology sex=male age=5.5 height=110 weight=19
```

### Usage
```
childmetrics --list                              # List all 33 tools
childmetrics auxology sex=male age=5.5 height=110 weight=19   # key=value mode
childmetrics bmi --args '{"weight":70,"height":175}'           # JSON mode (for LLM agents)
childmetrics bmi --schema                        # OpenAI function schema for one tool
childmetrics --schemas                           # All schemas (OpenAI function-calling format)
childmetrics bmi --format json                   # Machine-readable JSON output
```

### Output Formats
- **Human-readable** (default): Colored table with labels, values, units, percentiles, reference dataset info, and clinical warnings.
- **JSON** (`--format json`): Raw `ToolResult[]` array — same structure the web app uses internally. Each result has `label`, `value`, `unit`, `sds`, `percentile`, `warning`, `tag`, `referenceDataset` fields.

### LLM Agent Integration
The `--schemas` flag outputs all tool definitions in OpenAI function-calling format. An LLM agent can:
1. Fetch schemas: `childmetrics --schemas`
2. Select the appropriate tool based on the user's query
3. Call the tool: `childmetrics <tool> --args '{"param":"value"}' --format json`
4. Parse the JSON output to formulate a response

All parameter names use camelCase (e.g. `headCircumference`, `gestationalWeeks`). The CLI also accepts kebab-case (`head-circumference`) and case-insensitive matching.

### npm Packages
- **ceddcozum** — Primary package (https://www.npmjs.com/package/ceddcozum)
- **childmetrics** — Alias package (https://www.npmjs.com/package/childmetrics)

### License
Apache-2.0 © Çocuk Endokrinolojisi ve Diyabet Derneği (ÇEDD) / Turkish Society for Pediatric Endocrinology and Diabetes (TSPED)

## How-To Guide (Website Features)

### Bulk Data & Longitudinal Tracking
Many tools support batch processing and longitudinal patient tracking via the spreadsheet icon (⊞) in each tool's top-right toolbar:

1. **Download Template**: Get a pre-formatted Excel template with the correct headers for the selected tool. Fill in your data rows and re-upload.
2. **Upload Data (Excel/CSV)**: Upload a completed template. Single row auto-fills the form; multiple rows trigger batch processing with a results modal showing success/error counts and a downloadable Excel with all calculated SDS and percentiles.
3. **Manual Input (Longitudinal)**: Enter multiple measurement rows directly in the browser for tracking one patient over time.
4. **Growth Chart Visualization**: If all uploaded rows share the same birth date and sex (single patient detected), the system offers a "Visualize on Charts" button to plot the patient's growth trajectory against reference percentile curves.

**Tools with bulk data support:** Auxology, Height Velocity, IGF SDS, BMD SDS, Phosphate SDS, Blood Pressure, ABPM, Thyroid Volume, Body Ratios, Uterus/Ovary Volume.

### Syndrome-Specific Growth Charts
On the Auxology page, select a condition from the "Condition" dropdown to use syndrome-specific growth references. Supported: Turner (5 datasets), Achondroplasia (4), Down, Noonan (3), Prader-Willi (2), Silver-Russell, Marfan, Williams, Hypochondroplasia, XLH, Osteogenesis Imperfecta (Types I/III/IV), MPS (II, IVA, VI), Klinefelter.

### Switching Reference Datasets
Change the "Dataset" dropdown (Neyzi, WHO, CDC) to recalculate with a different reference population. Alternative dataset buttons also appear in the results panel after each calculation.

### AI Chatbot (ÇEDD GPT)
The chatbot icon in the top header opens ÇEDD GPT, a natural language calculator assistant. Type measurements in plain Turkish or English (e.g. "5 yaşında erkek, boy 110 cm") and it calls the appropriate calculator tool automatically. Results are computed locally, not by the AI.

### Offline & PWA
Visit the /download page to install Child Metrics as a Progressive Web App for offline use on any device.

## Languages
English, Turkish (toggle in header)

## Contact
https://childmetrics.org/contact