It is also important to evaluate the child’s feeding history and behaviour during meals. Malabsorption should be suspected when a child does not grow despite having a higher caloric intake than would be needed normally. Poor growth despite adequate intake may be seen in children with an endocrine disease, renal failure, renal tubular acidosis ( 11) or a genetic syndrome. Children with a chronic or recurrent infection, an immune deficiency, inflammatory bowel disease ( 10) or celiac disease often have poor caloric intake while experiencing few or no gastrointestinal symptoms. Most of the time, inadequate intake occurs in perfectly normal children, but children with a chronic disease are often poor eaters. Caloric intake that is considered ‘adequate’ based on the child’s actual weight is insufficient for catch-up growth. Caloric intake can be calculated from a 72 h food diary and compared to age-appropriate requirements with the help of a nutritionist. After the age of three, there should be no more change in growth percentile until puberty.Ī complete nutritional history needs to be obtained. After that time, growth resumes at a normal rate but parallel to or under the growth curve, or along the lower growth percentiles during the prepubertal years. Growth patterns also depend on feeding, with breastfed infants often growing faster than formula-fed infants in the first six months of life, and formula-fed babies growing faster after six months.Ĭhildren with a constitutional growth delay will start showing retarded linear growth in the first three years of life. After birth, there may be some ‘catch-up’ if an infant was born smaller than her/his genetic potential, or a ‘catch-down’ if the child was born larger than his/her genetic potential. Intrauterine growth may be affected by external factors (eg, maternal malnutrition or smoking, gestational diabetes, placental insufficiency). Crossing two major channels on the WHO growth charts would represent a greater change, and one that cannot be considered ‘normal’.īirth weight and length are strong predictors of subsequent growth ( 6), but do not always reflect a child’s genetic potential. Smith’s estimates cannot be applied to the WHO growth charts because the major percentiles charted are different (the 0.1 percentile, 3rd, 15th, 50th, 85th, 97th, 99.9th percentile). Using the National Center for Health Statistics (CDC) growth charts (showing the third, 10th, 25th, 50th, 75th, 90th and 95th percentile), DW Smith showed that as many as 30% of normal children crossed one major percentile line and 23% crossed two in the first two years of life ( 5). While children usually follow the same percentile for weight and height (or length) for most of childhood, children growing normally may also change percentiles in their first two or three years, to adjust toward their genetic potential ( 4).
0 Comments
Leave a Reply. |
Details
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |