British growth charts for height and weight with recommendations concerning their use in auxological assessment

The past, present, and future of child growth monitoring: A review and primer for clinical genetics

Child growth measurements are critical vital signs to track, with every individual child growth curve potentially revealing a story about a child's health and well-being. Simply put, every baby born requires basic building blocks to grow and thrive: proper nutrition, love and care, and medical health. To ensure that every child who is missing one of these vital aspects is identified, growth is traditionally measured at birth and each well-child visit. While the blue and pink growth curves appear omnipresent in pediatric clinics, it is surprising to realize that their use only became standard of care in 1977 when the National Center for Health Statistics (NCHS) adopted the growth curve as a clinical tool for health. Behind this practice lies a socioeconomically, culturally, and politically complex interplay of individuals and institutions around the world. In this review, we highlight the often forgotten past, current state of practice, and future potential of this powerful clinical tool: the growth reference chart, with a particular focus on clinical genetics practice. The goal of this article is to understand ongoing work in the field of anthropometry (the scientific study of human measurements) and its direct impact on modern pediatric and genetic patient care.

A Study on New IAP 2015 Growth References in Rural South Indian Children

OBJECTIVES

To ascertain the utility of the new pan Indian 2015 IAP references in rural South Indian children and the ability of new IAP charts to recognise children with abnormal cardiometabolic risk factors in 10 to 16 y age group.

METHODS

Among school health camps conducted at two centres of Tamil Nadu- rural Vellore and rural Erode- height, weight, waist circumference, blood pressure, triceps skin-fold thickness and body fat percentage were measured by trained pediatricians and Z-scores calculated. The anthropometric measures were studied as per IAP 2015 references and compared to other national and international references. Their utility in identification of malnutrition and cardiometabolic risk ascertained.

RESULTS

A total of 420 children (210 from Erode and 210 from Vellore) in the age group of 10 to 16 y were included in the study. New IAP references recognized more short stature (4.2 vs. 3%), wasting (11 vs. 1.5%) and overweight (14.2 vs. 13.2%) children compared to old IAP charts. The Z-scores of anthropometric measures as per New IAP 2015 references had significant correlation with old IAP and other international data (p < 0.05). It was noted that new IAP charts could detect 83.3%, old IAP chart 50% and WHO 83.3% of subjects with malnutrition. New IAP charts could detect 70.3% cardiometabolic risk associated with over nutrition compared to old IAP (57.4%) and WHO (51.8%).

CONCLUSIONS

There is a significant prevalence of both under nutrition and overweight in rural setting. IAP 2015 reference is useful to diagnose children with under nutrition and overweight including abnormal cardiometabolic risk.

Acid-labile subunit deficiency and growth failure: description of two novel cases

BACKGROUND/AIMS

Mutations in the acid-labile subunit (ALS) gene (IGFALS) have been associated with circulating insulin-like growth factor I (IGF-I) deficiency and short stature. Whether severe pubertal delay is also part of the phenotype remains controversial due to the small number of cases reported. We report 2 children with a history of growth failure due to novel IGFALS mutations.

METHODS

The growth hormone receptor gene (GHR) and IGFALS were analyzed by direct sequencing. Ternary complex formation was studied by size exclusion chromatography.

RESULTS

Two boys of 13.3 and 10.6 years, with pubertal stages 2 and 1, had mild short stature (-3.2 and -2.8 SDS, respectively) and a biochemical profile suggestive of growth hormone resistance. No defects were identified in the GHR. Patient 1 was homozygous for the IGFALS missense mutation P73L. Patient 2 was a compound heterozygote for the missense mutation L134Q and a novel GGC to AG substitution at position 546-548 (546-548delGGCinsAG). The latter causes a frameshift and the appearance of a premature stop codon. Size exclusion chromatography showed no peaks corresponding to ternary and binary complexes in either patient.

CONCLUSION

Screening of the IGFALS is important in children with short stature associated with low serum IGF-I, IGFBP-3 and ALS.

Body height and weight of children in Novi Sad

BACKGROUND

Height and weight are the most important measures of growth and development and indirect indicators of living conditions. The socio-economic conditions in Serbia have varied drastically. In 1990, a political and economic crisis started causing a rapid fall of standards of living.

AIM

The study aimed to determine the height and weight of children aged 3-11 in the periods between 1971, 1981, 1991 and 2001 in Novi Sad, Serbia.

SUBJECTS AND METHODS

This investigation was carried out in the same primary schools and pre-school institutions. The data included children of Serbian nationality born in Novi Sad whose parents were also born there and had the same socio-economic background.

RESULTS

Positive changes in height and weight were recorded in the decades 1971-1981 and 1981-1991, except for the height of 8-year-old children. In the period 1991-2001, an increase in height was observed only at the age of 8 in boys and until the age of 9 in girls. As for weight, an increase was recorded in 9-year-old boys, while in girls it was present at all ages except for the ages of 7 and 10. Considering the period 1971-2001, positive changes in height were recorded from the age of 6 in boys and 5 in girls. The changes in weight were positive at all ages except the age of 5 in boys and after the age of 6 in girls.

CONCLUSION

Lower values of height and weight recorded in 2001 are probably due to the changes in living conditions or they indicate that the acceleration reached its peak.

Growth patterns and secular trends over four decades in the dynamics of height growth of Indian boys and girls in Sri Aurobindo Ashram: A cohort study

BACKGROUND

Growth parameters are widely used in the assessment of health, nutrition and physical characteristics of a population; however, there still exist uncertainties regarding ethnic variation and the influence of physical activity on growth. Due to the paucity of longitudinal data, the dynamics of the adolescent growth spurt have not been satisfactorily examined in most populations.

AIM

The main purpose of this longitudinal study is to present the secular trends in the dynamics of height growth over four decades. In the process, this paper also aims to establish current norms for some biological parameters of growth and to address issues concerning ethnic variation and the effect of childhood physical activity on growth.

METHODOLOGY

Three hundred and one boys and 235 girls of Indian origin who had been enrolled in the Sri Aurobindo International Centre of Education (SAICE) by age 6 and remained for at least 3 uninterrupted years were divided into four birth cohort periods. Cross-sectional and longitudinal analyses were carried out to derive distance, velocity and acceleration curves.

RESULTS

No significant differences were found between ethnic groups in any of the growth parameters. Over the 40-year span of this study, SAICE children prove to be taller than their Indian peers. A significant positive secular trend was seen in the height attained at all velocity turning points over the first two decades. Most pre-pubertal growth parameters in these children resemble those from developed nations.

CONCLUSIONS

Children from most parts of India have similar genetic growth potential. After a significant positive secular trend in height attained over the first 20 years, the adult height has now plateaued. The significant difference in post-pubertal stature between the current generation and those of European origin indicates a genetic difference. Regular and graded physical activities have a salutary effect on growth. The data provide norms for healthy, active Indian child growing up in a satisfactory environment.

Clinical and endocrine features and long-term outcome of Graves' disease in early childhood

Hyperthyroidism is rare in early childhood and most commonly caused by Graves' disease. We report 14 children (4 boys, 10 girls) aged 3.4-7.5 yr. At diagnosis, all patients had weight loss, hyperkinetic activity, tachycardia, difficulty sleeping, and poor concentration and 11 presented with proptosis. Four patients developed long-term neuropsychological problems. There was a family history in 7 cases. All patients had goiters, clinically assessed to be large and diffuse in 21%, medium-sized in 43%, and small in 36%. At diagnosis, height was increased with median (range) height; 1.25 standard deviation score (SDS) (-0.2-5.24) and body mass index (BMI) was decreased; -0.48 SDS (-1.65-1.26). Height and BMI SDS values were statistically different (p<0.032) Bone age was advanced in 4 of 5 children, who had assessments. Total or free T4 levels were elevated and TSH was undetectable. Ninety percent of patients (12/14) had positive thyroid peroxidase autoantibodies, mean level 680 IU/ml (range 50-1347). Initial treatment was with antithyroid medication using carbimazole; median dose 0.75 mg/kg/day (no.=13) or propylthiouracyl 15 mg/kg/day (no.=1). T4 was added in 6 patients. Normalisation of serum T4 occurred at 4 months (1- 9) and TSH at 7 months (3-24) after start of therapy. Treatment was discontinued after a minimum of 2 yr in 11 patients, relapse occurring in 9. Median duration of total therapy was 58 months (18-132). During adolescence, 4 patients had curative therapy by surgery (no.=2) or radioiodine (no.=2). In conclusion, disturbance of growth, behavioral difficulties and infrequent spontaneous remission are key features of Graves' disease in early childhood.

Two Brothers with Non-Classical 21-Hydroxylase Deficiency: To Treat or Not to Treat?

Variations in phenotype in 21-hydroxylase deficiency (21OHD) have cautioned against initiating treatment in the absence of abnormal clinical features. We report 2 Caucasian brothers with compound heterozygous mutations of the CYP21 gene and mild clinical and biochemical features of late-presenting 21OHD. The index case presented aged 8.5 years with mild genital virilization and bone age advanced by 5 years. Elevated basal and synacthen-stimulated 17-hydroxyprogesterone (17OHP; 22.4 and 246 nmol/l) and androstenedione (10.9 and 19.9 nmol/l) levels confirmed 21OHD. His younger brother was investigated at age 7.3 years, and although examination showed normal pre-pubertal genitalia, basal and synacthen-stimulated 17OHP (32.4 and 281 nmol/l) and androstenedione (6.2 and 9.0 nmol/l) were abnormal, and bone age was advanced by 1.5 years. Because of actual or incipient virilization, both patients were treated with glucocorticoid replacement 8-12 mg/m(2)/day. This decision is discussed in the context of published guidelines for the management of 21OHD.

Approaches to detecting growth faltering in infancy and childhood

One of the purposes of monitoring a child's weight or height is to detect growth faltering. In infancy the focus is on monitoring weight gain, primarily for detecting infants at risk of failure-to-thrive. In childhood, this switches to height gain, e.g. the response of a child that is growth hormone deficient to treatment with growth hormone. Cross-sectional charts provide no guidance in a longitudinal context. If we note the current weight or height of a child, but want to say something about a child's growth since the last weight and height measurement, we need to use a velocity/increment reference or take a conditional approach to the problem. Here we focus on growth faltering and review the mathematical approaches to this problem. Discussion will concentrate on the relative merits of the following approaches: velocity references and increment charts or tables; conditional gain Z-scores;infancy weight-monitoring charts and longitudinal growth norms implemented in the growth package LGROW; tracking indices and distance charts and centile crossing. Overall conditional gain Z-scores provide the most flexible means of assessing growth patterns.