Growth and growth charts

Images

Food and foetus and neonate

Although intra-uterine growth can be monitored effectively and postnatal size can be accurately measured, it is still difficult to differentiate between undergrown and small normal infants. Biochemical measurements are of little help, but arm anthropometry looks promising. Infants who are undergrown have certain physiological handicaps in the neonatal period, such as impaired nutrient absorption and increased resting metabolism, which add to their nutritional difficulties. More studies on the physiological differences between undergrown and normal infants may help to improve the precision with which they may be distinguished.

Evaluation and prognosis in nonorganic failure to thrive

The 70 children with failure to thrive (FTT) admitted to our hospital over the last five years were reviewed. After extensive evaluations, only 16% received a diagnosis of an organic disorder. In the nonorganic group, 45% of FTT was secondary to improper feeding and 52% was secondary to environmental deprivation. Thirty percent of the children were discharged without a diagnosis. Although there were some important differences between the groups, extensive laboratory data were of little value. Follow-up information revealed that while the children with FTT secondary to poor feeding technics uniformly did well, the outlook for the environmentally deprived group and unknown cause group was frequently poor.

A follow-up study of infants with adverse reactions to cow's milk. I. Serum IgE, skin test reactions and RAST in relation to clinical course

47 infants with cow's milk sensitivity were followed for a period varying between 6 months to 4 years (mean 28 months). The age at onset of symptoms varied between 14 days to 20 months. The clinical course was studied in relation to reaginic allergy by use of serum IgE, skin prick test and RAST. Infants with an immediate onset of symptoms from the gastrointestinal tract and the skin after cow's milk intake were discerned as a distinct entity having a high frequency of atopy in the family, positive skin tests and positive RASTs to milk (71%). Cases with delayed reactions to cow's milk seldom had a positive RAST or skin test. Most infants of both groups showed an increasing tolerance to milk. In RAST positive infants the RAST-titers increased significantly after onset of symptoms. After having reached a peak the titers subclined in several cases. The titers did not reflect the degree of milk sensitivity during the follow-up period. However, infants who developed high titers seemed to develop tolerance more slowly than infants with low titers.

Serum ferritin in assessment of iron nutrition in healthy infants

We followed up 238 infants on 7 occasions during their first year of life. The diets of the infants were systematically either supplemented or not supplemented with iron. Developmental changes in serum ferritin were determined from a group with adequate intake of iron and without evidence of iron deficiency by three laboratory criteria: hemoglobin, mean corpuscular volume and transferrin saturation. The data indicate that the average level of serum ferritin correlates well with iron nutrition within groups of infants since the developmental changes are in accordance with the known changes in storage iron, the level of serum ferritin correlates with iron intake, and low ferritin levels are associated with lower transferrin saturation. The usefulness of serum ferritin as the sole criterion of iron deficiency in individual infants is limited, suggesting the use of more than one indicator to refine the diagnosis of iron deficiency without anemia.

Failure to thrive. The role of clinical and laboratory evaluation

One hundred eighty-five patients hospitalized for evaluation to thrive were reviewed retrospectively. Eighteen percent had proven organic etiologies. The specific organic diagnosis was strongly suggested by the history and physical examination in all of these patients. Fifty percent of the patients were failing to thrive on the basis of environmental deprivation. Only 1.4% of the laboratory studies performed were of positive diagnostic assistance. No study was of positive value without a specific indication from the clinical evaluation. The history and physical examination are the most valuable tools in the evaluation of failure to thrive. Laboratory investigations are rarely helpful without a specific indication from the clinical evaluation.

Spectrum analysis of the cry sounds of well-nourished and malnourished infants

The cry sounds of 12 well-nourished and 12 malnourished male infants were compared using behavioral and acoustic measures. The cry of the malnourished infant had an initial longer sound, higher pitch, lower amplitude, more arrhythmia, and a longer latency to the next cry sound than the cry of the well-nourished infant. The similarity betweenthe cry of the malnourished infant and the cry of the brain-damaged infant suggested tha malnutrition may affect the regulatory function of the central nervous system. This hypothesis was supported by additional findings which showed that the abnormal cry patterns in the malnourished infants were associated with a low-level orienting response to a pure tone stimulus as measured by the magnitude of heart-rate deceleration.

Ethnic differences in growth potential of children of African, Indian, Chinese and European origin

Community surveys of infants and children of African, Indian, Chinese and European origin in Guyana and Jamaica have been reviewed in order to compare the influence of ethnic origin and environment, including nutrition, on anthropometric measurements used to assess nutritional status. Mean heights and weights of African and European were greater than those of Indian and Chinese children. African had greater weight for height and greater arm circumferences but smaller triceps skinfolds than Indian children. These differences, which cannot be explained by nutritional or other environmental causes, show that ethnic origins cannot be disregarded when assessing nutritional status by anthropometric measurements. Specific adjustments to international standards of height and weight are proposed in order to make them more appropriate for Indian and Chinese children.

Growth of Zambian children

In order to identify as early as possible those children who may later develop malnutrition, a sample of Zambian copper-miners' children of known age and birth weights were measured at the age of one year and again at 18 months. By this time, their mean weight, height, triceps skin-fold, arm circumference and developmental progress were less than expected and many were, or had been ill, with malnutrition and infections. The slower growth corresponded significantly with lower development scores. The mean values of the physical measurements resemble those previously observed in Zambia, and it is concluded that the "Harvard" and Tanner standards are suitable for use in this country. The mid upper arm circumference is the easiest and cheapest measurement to make and it compares closely with other measures. A value of 15 cm or less from the age of seven months onwards in young children should arouse suspicion that their nutrition is at risk.

Infants with earache

Of 66 babies under the age of 3 months, who were examined during a 6-month period for excessive or unusual crying, and who showed no signs of fever, diarrhoea, vomiting, blocked nose, skin eruptions, and difficulties with breast- or bottle-feeding, 9 had pus or mucus in the middle ear. All who care for young children should be skilled in examining them for otitis media.

Weight/length classification of nutritional status

The use of somatic measurements for the assessment of nutritional status is briefly reviewed. Two classifications using weight and length being advocated at present--those of McLaren and Read (1972) and Waterlow and Rutishauser (1974)--were applied to data from three sets of children surveyed in hospital and field studies. The results obtained differed considerably. The system of Waterlow and Rutishauser tended to underestimate the problem. A simple chart has been devised to aid the practical application of the classification of McLaren and Read.

Arm circumference in the surveillance of protein-calorie malnutrition in Baghdad

A comparison is made between the percentage of Boston weight for age standards and the percentages of mid-upper arm for age standards of 777 Baghdad children aged 3-72 months. They showed a significantly high correlation of 0.92 (P smaller than 0.001). The percentage wieght for age could be predicted from percentage arm for age standard within plus or minus 16%. A constant midpoint arm circumference standard of 16.5 cm was suggested for use in children aged 13-72 months, when precise ages are unknown. This seems to work as well as the age specific arm standard in this age group, and is age independent. The constant arm standard is probably as satisfactory as that of weight for age, and has many practical advantages, especially under field conditions, when precise ages of children are unknown.

Tyrosinemia and tyrosyluria in healthy prematures: time courses not vitamin C-dependent

Tyrosyluria and for a part also tyrosinemia were studied in 60 healthy prematures of various birth weights and gestational ages. The first analyses were performed between the 6th and the 14th day after birth. A normal milk diet was given and the protein-intake was between 3 and 4 g/kg. After the first collection of urine half the patients received extra ascorbic acid, 100 mg/kg daily. Urinary analyses of tyrosine and p-hydroxyphenyl metabolites were performed once a week, until the excretion of p-hydroxyphenylpyruvic plus p-hydroxyphenyllactic acids was lower than 5 mmoles per gram creatinine. In 22 out of the 60 prematures (or 37%) a tyrosyluria of more than 5 mmoles/g creatinine and in 19 out of 44 (43%) patients analysed serum tyrosine was higher than 5 mg/100 ml at first analysis. No inverse correlation between tyrosyluria and tyrosinemia on the one hand and birth weight and gestational age on the other hand existed. But in children with a delayed intra-uterine development the incidence of tyrosyluria was higher as prematurity was more pronounced. Ascorbic acid had no effect on the rate of disappearance of tyrosyluria. It was concluded that the addition of extra vitamin C to the diet of prematures is not useful for the normalization of tyrosine metabolism.

Association of growth status and the incidence of nutrition deficiency signs

The validity of using the index weight--height in the assessment of nutritional status was evaluated. The suitability of the index and its relation to growth status and nutritional deficiency signs were assessed through the: 1) comparison of incidence rates of nutrition deficiency signs and growth rates by scales of overall weight--height values less than or above 0.15; 2) comparison of growth rates and incidence of nutrition deficiency signs by classification of children depending on the frequency with which they maintained the index above or below 0.15; and 3) intercorrelations between growth rates, incidence rates of PCM, and absolute values of weight--height index.

Nutritional status and mortality: a prospective validation of the QUAC stick

In December 1970, 8,292 rural Bengali children the ages of 1 and 9 had their height and arm circumference measured. Eighteen months later the fate of 98.8% of these children was ascertained. Overall, 2.3% of the children had died. Those the 9th and between the 10th and 50th percentiles of arm circumference for height were at 3.4 1.5 times greater risk of dying, respectively, than those above the 5oth percentiles. A gradient was present at every age, although it was greatest for the bulnerable 1- to 4-year age group, for whom the relative risks were 4.5, 1.6, and 1.0, respectively. The discriminant efficiency of these categories was greatest immediately following measurement and decreased with time. During the first postmeasurement month the risk of dying the poorest nutritional category was 19.8 times that of the best, and for the first 3 months, 12.2 times. By the last 3 months of followup it was only twice that of the best. Females in all three categories fared slightly worse than males, being at 1.1 times the risk of dying. This same vulnerable group of 1. to 4-year olds could be identified without knowing their age. Limiting the analysis to children whose heights were between 65 and 89 cm resulted in relative risks, for the three categories, of 4.1, 1.6, and 1.0, respectively. These arm circumference to height categories and the QUAC stick survey technique for which they were devised appear to be valid tools for identifying nutritionally disadvantaged individuals and populations at high risk of death.