Predicting longitudinal growth curves of height and weight using ecological factors for children with and without early growth deficiency

Catch-Up Growth in Infants and Young Children With Faltering Growth: Expert Opinion to Guide General Clinicians

Faltering growth (FG) is a problem regularly seen by clinicians in infants and young children (<2 years of age). It can occur due to non-disease-related and disease-related causes and is associated with a wide range of adverse outcomes, including shorter-term effects such as impaired immune responses and increased length of hospital stay, and longer-term consequences, including an impact on schooling and cognitive achievements, short stature, and socioeconomic outcomes. It is essential to detect FG, address underlying causes and support catch-up growth where this is indicated. However, anecdotal reports suggest misplaced fear of promoting accelerated (too rapid) growth may deter some clinicians from adequately addressing FG. An invited international group of experts in pediatric nutrition and growth reviewed the available evidence and guidelines on FG resulting from disease-related and non-disease-related effects on nutritional status in healthy term and small for gestational age infants and children up to the age of 2 years in low-, middle-, and high-income countries. Using a modified Delphi process, we developed practical consensus recommendations to provide clarity and practical recommendations for general clinicians on how FG should be defined in different young child populations at risk, how FG should be assessed and managed, and the role of catch-up growth after a period of FG. We also suggested areas where further research is needed to answer remaining questions on this important issue.

Predictive modeling of neurobehavioral state and trait variation across development

A key goal of human neurodevelopmental research is to map neural and behavioral trajectories across both health and disease. A growing number of developmental consortia have begun to address this gap by providing open access to cross-sectional and longitudinal 'big data' repositories. However, it remains challenging to develop models that enable prediction of both within-subject and between-subject neurodevelopmental variation. Here, we present a conceptual and analytical perspective of two essential ingredients for mapping neurodevelopmental trajectories: state and trait components of variance. We focus on mapping variation across a range of neural and behavioral measurements and consider concurrent alterations of state and trait variation across development. We present a quantitative framework for combining both state- and trait-specific sources of neurobehavioral variation across development. Specifically, we argue that non-linear mixed growth models that leverage state and trait components of variance and consider environmental factors are necessary to comprehensively map brain-behavior relationships. We discuss this framework in the context of mapping language neurodevelopmental changes in early childhood, with an emphasis on measures of functional connectivity and their reliability for establishing robust neurobehavioral relationships. The ultimate goal is to statistically unravel developmental trajectories of neurobehavioral relationships that involve a combination of individual differences and age-related changes.

Association of mental health problems in childhood with prenatal and postnatal physical growth

Aims

The present study was conducted to examine (i) prenatal and postnatal patterns of growth in relation to the risk of later mental health problems in children and (ii) the possible mediating effect of these patterns of growth in the association between parental socioeconomic status (SES) and children’s mental health.

Subjects and methods

The present study is part of a blinded, matched case control study, involving a retrospective analysis of prospectively collected data from routine examinations at community health services for children and adolescents. The sample comprised 80 patients, referred between the age of 6–13 years to the Community Mental Health Centre in Maastricht, and 320 matched population controls.

Results

Children coming from unemployed families weighed less at birth, but postnatal growth was not associated with this or other indicators of SES. Although children using mental health care were somewhat smaller at birth, there was no evidence that leanness during childhood was a risk factor for the development of mental health problems.

Conclusions

The present results showed some evidence for the impact of intrauterine development on children’s mental health problems. In addition, neither prenatal nor postnatal physical growth were on the pathway between parental SES and children’s mental health problems.

Maternal anemia and offspring failure to thrive - results from a large population-based cohort

Objective: To evaluate whether an association exists between maternal anemia and offspring failure to thrive (FTT) during childhood.Methods: A population-based cohort analysis was performed, comparing the risk for FTT among children (up to 18 years old) based on maternal hemoglobin (Hb) levels, upon postpartum discharge. Maternal Hb levels were categorized into 3 levels: <9.0 (moderate-severe anemia), 9.0-11.0 (mild anemia), and ≥11.0 g/dL (no anemia). FTT diagnosis was based on hospital records. All singletons born between 1991 and 2014 and discharged alive without congenital malformations were included. A survival curve was constructed to compare the cumulative FTT incidence, and a Weibull parametric survival analysis to assess the independent association between maternal anemia and offspring FTT while controlling for confounders.Results: Of the 214,305 included deliveries, 22,071 parturients (10.3%) were discharged with Hb <9.00; 83,932 (39.2%) with Hb between 9.0-11.0; and 108,302 (50.5%) with Hb ≥11.0 g/dL. FTT rates were 1.3% (n = 287), 1.2% (n = 967), and 1.1% (n = 1141) in the same groups, respectively (p = .003). The survival curve demonstrated a significantly higher cumulative incidence of FTT diagnosis in the moderate-severe maternal anemia group (p < .001). In the Weibull analysis, constructed for newborns with appropriate birthweight, both groups of maternal anemia were found to be independently associated with FTT related hospitalizations (mild anemia aHR, 1.1; 95%CI 1.002-1.219; p = .045, moderate-severe anemia aHR, 1.321; 95%CI, 1.141-1.529; p < .001).Conclusion: Maternal anemia is independently associated with long-term FTT in offspring, with increasing FTT rates proportional to anemia severity.

Mother's nutrition-related knowledge and child nutrition outcomes: Empirical evidence from Nigeria

BACKGROUND

Nutrition outcomes among young children in Nigeria are among the worse globally. Mother's limited knowledge about food choices, feeding, and health care seeking practices contributes significantly to negative nutrition outcomes for children in most developing countries. Much less is known about the relationship between mother's nutrition-related knowledge and child nutritional outcomes in rural Nigeria. This paper investigates therefore: (i) the association of mother's nutrition-related knowledge with nutrition outcomes of young children living in rural Nigeria, where access to education is limited, and (ii) whether mother's education has a complementary effect on such knowledge in producing positive child nutrition outcomes in such settings.

METHODS

Using the Demographic and Health Survey data for Nigeria, we employ both descriptive and regression analyses approaches in analyzing the study's objectives. In particular, we apply ordinary least square (OLS) to investigate the association of mother's nutrition-related knowledge with child HAZ and WHZ while controlling for maternal, child, household and regional characteristics. An index was constructed for mother's nutrition-related knowledge using information on dietary practices, disease treatment and prevention, child immunization, and family planning.

RESULTS

We found that mother's knowledge is independently and positively associated with HAZ and WHZ scores in young children. Higher levels of mother's education, typically above primary, have a significant, positive association with child HAZ and WHZ scores. We argue that mother's knowledge of health and nutrition may substitute for education in reducing undernutrition in young children among populations with limited access to formal education. However, the present level of mother's education in rural Nigeria appears insufficient to reinforce knowledge in producing better nutrition outcomes for children.

CONCLUSIONS

This study suggests promotion of out-of-school (informal) education, such as adult literacy and numeracy classes where women without formal education can gain health and nutrition knowledge, and practices that could enhance child nutrition outcomes in Nigeria.

Risk of metabolic consequences of rapid weight gain and catch-up growth in the first two years of life: a systematic review protocol

REVIEW QUESTION

The specific review question to be addressed in this review is: what is the risk of metabolic outcomes for individuals who experience rapid weight gain or catch-up growth during the first two years of life?

Postnatal growth velocity and overweight in early adolescents: a comparison of rural and urban African boys and girls

Objectives

To compare growth velocity of two African child cohorts and examine the relationship between postnatal growth velocity in infancy/early childhood and the risk of overweight/stunting in early adolescence.

Methods

The study used data from two child cohorts from urban (Birth to Twenty Cohort, South Africa) and rural (Lungwena Child Survival Study, Malawi) African settings. Mixed effect modelling was used to derive growth and peak growth velocities. T-tests were used to compare growth parameters and velocities between the two cohorts. Linear and logistic regression models were used to determine the relationship between growth velocity and early adolescent (ages 9–11 years) body mass index and odds of being overweight.

Results

Children in the BH cohort were significantly taller and heavier than those in the Lungwena cohort, and exhibited faster weight and height growth velocity especially in the first year of life (P < 0.05). No significant association was shown between baseline weight (α_w) and overweight in early adolescence (OR = 1.25, CI = 0.67, 2.34). The weight growth velocity parameter β_w was highly associated with odds of being overweight. Association between overweight in adolescence and weight velocity was stronger in infancy than in early childhood (OR at 3 months = 4.80, CI = 2.49, 9.26; OR at 5 years = 2.39, CI = 1.65, 3.47).

Conclusion

High weight and height growth velocity in infancy, independent of size at birth, is highly associated with overweight in early adolescence. However, the long term effects of rapid growth in infancy may be dependent on a particular population's socio-economic status and level of urbanization. Am. J. Hum. Biol. 26:643–651, 2014. © 2014 The Authors American Journal of Human Biology Published by Wiley Periodicals, Inc.

Child diet and healthy growth in the context of rural poverty in the peruvian andes: what influences primary caregivers' opportunities and choices?

This study explored opportunities and choices related to child feeding among women living in a remote and low-income district in the Andean highlands. Data were collected through in-depth interviews with mothers (N = 7) with reputations for providing good child care, and who participated in an NGO-run social and health programme. The aim of this study was to learn about women's positive experience with child feeding, in the context of living in low-income communities. Such knowledge could be of substantial practical value to health promotion practitioners, in illuminating existing local circumstances and practices that produce good child nutrition. The women who were most knowledgeable about child health and diet were better educated and had relatively higher social positions in the community. Regarding contextual factors related to child feeding, numerous references were made to the extensive use of own crops and food stuffs, seen to provide a better diet than that available in cities where people buy their food. In discussing food and meal preparation habits, there were clear references to child welfare and health as motivating factors in the choices that were made. The NGO programme was not mentioned by the interviewer, to avoid prompting, yet the respondents referred to it explicitly, and attributed improved health-related knowledge and skills to the NGO education interventions (e.g. education about nutritious meal preparation, child care skills, and sanitation practices). It is concluded that the women were concerned about providing a good diet to their children, they were aware of the impact of feeding practices on child health, and that education about health and diet helped them to improved feeding practices.

Multi-level modelling of longitudinal child growth data from the Birth-to-Twenty Cohort: a comparison of growth models

Background: Different structural and non-structural models have been used to describe human growth patterns. However, few studies have compared the fitness of these models in an African transitioning population.

Aim: To find model(s) that best describe the growth pattern from birth to early childhood using mixed effect modelling.

Subjects and methods: The study compared the fitness of four structural (Berkey-Reed, Count, Jenss-Bayley and the adapted Jenss-Bayley) and two non-structural (2nd and 3rd order Polynomial) models. The models were fitted to physical growth data from an urban African setting from birth to 10 years using a multi-level modelling technique. The goodness-of-fit of the models was examined using median and maximum absolute residuals, Akaike Information Criterion (AIC) and Bayesian Information Criterion (BIC).

Results: There were variations in how the different models fitted to the data at different measurement occasions. The Jenss-Bayley and the polynomial models did not fit well to growth measurements in the early years, with very high or very low percentage of positive residuals. The Berkey-Reed model fitted consistently well over the study period.

Conclusion: The Berkey-Reed model, previously used and fitted well to infancy growth data, has been shown to also fit well beyond infancy into childhood.

Height preferences in humans may not be universal: evidence from the Datoga people of Tanzania

Many studies in Western societies have shown that women prefer relatively taller men as potential partners, whereas men prefer women who are slightly shorter than themselves. Here, we discuss possible limitations of previous results within the context of the stimuli used (i.e., differences in the perceived body size of female silhouettes). Our results show that, at least in a Polish sample (N=231), modified stimuli did not essentially change the observed male-taller preferences. In contrast, we report height preferences in a traditional ethnic group, the Datoga people from Tanzania (N=107), in which men and women preferred extreme sexual dimorphism in stature (SDS) sets (i.e., men and women chose women much taller or much shorter than themselves). Thus, our data do not accord with the suggestion of a universal preference for taller men, but rather suggests that height preferences may be influenced by cultural, environmental, and ecological conditions.

Challenge! Health promotion/obesity prevention mentorship model among urban, black adolescents

OBJECTIVES

The objective of this study was to evaluate a 12-session home/community-based health promotion/obesity prevention program (Challenge!) on changes in BMI status, body composition, physical activity, and diet.

METHODS

A total of 235 black adolescents (aged 11-16 years; 38% overweight/obese) were recruited from low-income urban communities. Baseline measures included weight, height, body composition, physical activity (PA), and diet. PA was measured by 7-day play-equivalent physical activity (> or =1800 activity counts per minute). Participants were randomly assigned to health promotion/obesity prevention that is anchored in social cognitive theory and motivational interviewing and was delivered by college-aged black mentors or to control. Postintervention (11 months) and delayed follow-up (24 months) evaluations were conducted. Longitudinal analyses used multilevel models with random intercepts and generalized estimating equations, controlling for baseline age/gender. Stratified analyses examined baseline BMI category.

RESULTS

Retention was 76% over 2 years; overweight/obese status declined 5% among intervention adolescents and increased 11% among control adolescents. Among overweight/obese youth, the intervention reduced total percentage of body fat and fat mass and increased fat-free mass at delayed follow-up and increased play-equivalent physical activity at postintervention but not at delayed follow-up. Intervention adolescents declined significantly more in snack/dessert consumption than control adolescents at both follow-up evaluations.

CONCLUSIONS

At postintervention, there were intervention effects on diet and PA but not BMI category or body composition. At delayed follow-up, dietary changes were sustained and the intervention prevented an increase in BMI category. Body composition was improved for overweight/obese youth. Changes in body composition follow changes in diet and PA and may not be detected immediately after intervention.

Analytic methods in Project HeartBeat!

Project HeartBeat! (1991-1995) was an observational study of the development of cardiovascular disease (CVD) risk factors in childhood and adolescence using an accelerated longitudinal design. The purpose of this paper is to explain the analytic methods used in the study, particularly multilevel statistical models. Measurements of hemodynamic, lipid, anthropometric, and other variables were obtained in 678 children who were enrolled in three cohorts (baseline ages 8, 11, and 14 years) and followed for 4 years, resulting in data for children aged 8-18 years. Patterns of change of blood pressure, serum lipid concentration, and obesity with age, race, and gender were of particular interest. The design specified 12 measurements of each outcome variable per child. Multilevel models were used to account for correlations resulting from repeated measurements on individuals and to allow use of data from incomplete cases. Data quality-control measures are described, and an example of multilevel analysis in Project HeartBeat! is presented. Multilevel models were also used to show that there were no differences attributable to the cohorts, and combining data from the three age cohorts was judged to be reasonable. Anthropometric data were compared with national norms and shown to have similar patterns; thus, the patterns seen in the CVD risk factors may be generalized, with some caveats, to the U.S. population of children.

Maternal Characteristics Determine Stunting in Children of Less than Five Years of Age Results from a National Probabilistic Survey

Background

Maternal nutrition and some variables are the main determining factors of birthweight and delayed intrauterine growth of children.

Objective

To explore the association between the mothers’ biological and sociodemographic characteristics, and the anthropometry status in children under five years of age.

Design

The population consisted of a sub-sample of 1,047 mother-and-child selected pairs from the probabilistic National Nutrition Survey, carried out in Mexico. Mother-and-child pairs included mothers aged 12 to 49 years, with children under five years of age. Data on sociodemographic characteristics, obstetric history, 24-hour recall dietary intake, and the women and children's anthropometry were collected. The association between maternal characteristics and children's anthropometry status was assessed using multiple logistic regression models.

Result

Nearly 16.7% of the children <5y of age were stunted (13.5% ≤ 2y and 18.8% > 2y). The height/age of the children was severely affected by maternal height and birth order. In addition, the interaction between socioeconomic level and maternal schooling had a marginal effect (p = 0.09) in the ≤2y group. On the other hand, whether the family received social services and the interaction between maternal height and a dichotomy urbanism variable were significant (p = 0.05) and (p < 0.01) respectively in >2y group.

Conclusion

Some biological and socioeconomic characteristics among mothers have a negative effect on their children's attained size, especially in the period between 2 and 5 years of age.

Anthropometric characteristics of Indian school children living in Bahrain

A cross-sectional study was carried out among Indian school children residing in Bahrain to assess their physical growth. The total sample of 1,437 Indian school children (718 males and 719 females) aged 6-18 years were selected by a systematic random sampling technique. Anthropometric measurements included measurement of height, weight, mid-arm circumference, biceps, triceps, subscapular, and suprailiac skinfold thickness.

RESULTS

Median height of the boys was between the 10th and 25th percentile of the National Centre for Health Statistics (NCHS) standard growth charts. In girls, the height varied between the 5th and 25th percentile, dipping to nearly the 5th percentile at 14 years. Median weight of the boys fluctuated between the 25th and the 50th percentile of the standard data and in girls, weight fluctuated between the 25th and 50th percentile. Girls had a higher mean body mass index (BMI) and body fat compared with the males at all age groups. The median BMI for both groups was between the 50th and 75th percentile of the standard charts. The median triceps skinfold in males was above the 85th percentile at 17 years, whereas in females, skinfold thickness was steady between the 50th and 85th percentiles of the growth charts.

CONCLUSION

Compared with their Bahraini counterparts, two distinct growth patterns were evident. When compared with early data, the Indian children were taller and heavier than their Bahraini counterparts. However, comparison with later data showed a reversal, whereby the Bahraini children were taller and heavier with a corresponding higher BMI.

Early intervention and recovery among children with failure to thrive: follow-up at age 8

OBJECTIVES

We sought to examine the impact of a randomized, controlled trial of home visiting among infants with failure to thrive on growth, academic/cognitive performance, and home/classroom behavior at age 8.

METHODS

Infants with failure to thrive (N = 130) or adequate growth (N = 119) were recruited from pediatric primary care clinics serving low-income, urban communities. Eligibility criteria included age <25 months, gestational age >36 weeks, birth weight >2500 g, and no significant medical conditions. Evaluation included anthropometries, Bayley scales, maternal anthropometries, demographics, negative affect, IQ, and the Home Observation for Measurement of the Environment scale. Infants with failure to thrive were treated in an interdisciplinary growth and nutrition clinic and randomized into clinical-intervention-plus-home-intervention or clinical-care-only groups. The home-visiting curriculum promoted maternal sensitivity, parent-infant relationships, and child development. Follow-up visits were conducted by evaluators who were unaware of the children's growth or intervention history. At age 8, the evaluation included anthropometries, the Wechsler Intelligence Scale for Children III, and the Wide Range Achievement Test, Revised. Mothers completed the Child Behavior Checklist and teachers completed the Teacher Report Form.

ANALYSIS

Multivariate analyses of variance were used to examine differences in growth, cognitive/academic performance, and home/school behavior, adjusted by maternal education, public assistance, and, when appropriate, infant Bayley score, maternal BMI, height, negative affect, IQ, and Home Observation for Measurement of the Environment scores.

RESULTS

Retention was 74% to 78%. Children in the adequate-growth group were significantly taller, heavier, and had better arithmetic scores than the clinical-intervention-only group, with the clinical-intervention-plus-home-intervention group intermediate. There were no group differences in IQ, reading, or mother-reported behavior problems. Children in the clinical-intervention-plus-home-intervention group had fewer teacher-reported internalizing problems and better work habits than the clinical-intervention-only group.

CONCLUSIONS

Early failure to thrive increased children's vulnerability to short stature, poor arithmetic performance, and poor work habits. Home visiting attenuated some of the negative effects of early failure to thrive, possibly by promoting maternal sensitivity and helping children build strong work habits that enabled them to benefit from school. Findings provide evidence for early intervention programs for vulnerable infants.

The influence of temperament on weight gain in early infancy

Difficult temperament has been associated with fast weight gain and slow weight gain, although the latter mostly in referred subjects studies in late infancy. The current study set out to investigate early weight gain in relation to all domains of temperament in a community-screened sample. Weight gain from birth to 8 weeks was assessed in 75 infants recruited from local health care clinics who had demonstrated slow, average, or fast weight gain. Mothers completed a temperament questionnaire and a 2-day diary recording infant behaviors (sleeping, feeding, fussing, and crying). Weight gain from birth to 8 weeks was significantly related to infant temperament. The temperament dimension fear (acceptance or rejection of new objects or persons) was related to slow weight gain and the temperament dimension distress to limitations (negative emotionality and the infant's reaction to frustrating situations) was related to fast weight gain. The regression model explained 59% of the variance, with the temperament dimensions explaining 11%. Diary data showed that infants who scored high on fear tended to cry a lot, while infants with high scores on distress to limitations tended to sleep less and cry and fuss more. The results emphasize that different temperament domains influence slow and fast weight gain. In addition, the data suggest that infant temperament plays a part in physical development in early infancy.

Agreement with Satisfaction in Adolescent Body Size between Female Caregivers and Teens from a Low-income African-American Community

OBJECTIVE

To describe body size satisfaction and agreement among low-income, urban, African-American adolescents, and female caregivers.

METHODS

Two hundred and fifteen adolescent-caregiver pairs completed measures of demographics, anthropometrics, and body size satisfaction.

RESULTS

Adolescent-caregiver agreement on body size satisfaction varied by body mass index (BMI) category. Among normal weight adolescents, 61% of adolescent-caregivers agreed that current body size was ideal. Among adolescents at risk for overweight, 38% of adolescent-caregivers agreed that current body size was ideal, and 38% were discordant with adolescents wanting to be thinner and caregivers satisfied with current body size. Among overweight adolescents, adolescent-caregiver agreement was 67%; 52% agreed the adolescent should be thinner and 15% agreed current body size was ideal.

CONCLUSIONS

Body size satisfaction is related to BMI category for adolescents and caregivers, but adolescents have a lower threshold. Encouraging caregivers to elicit their adolescents' views on body size satisfaction may enable caregivers to support their adolescents in addressing weight-related issues.

Eating behavior disorders in Chilean infants

Eating behavior disorders (EBD) are often observed in children. Most of the related research, however, has been performed in developed countries. In countries like Chile, characterization of food disorders during the first years of life is unknown.

OBJECTIVE

The goal of the current study is to characterize the EBD of Chilean children during the first 2 years of life.

METHODS

We studied 67 children (mean age = 5.4 months; range = 4-24 months). The study group (SG; according to criteria in the 4th ed. of the Diagnostic and Statistical Manual of Mental Disorders) consisted of 34 children with EBD whose mothers spontaneously consulted for difficulties for feeding and the control group (CG) included 33 healthy children. A structured recall was applied to their mothers.

RESULTS

EBD onset was observed more frequently during the first semester of life and was associated with new foods. The children in the SG presented with lower birth weight (SG: 3,000 +/- 500 g; CG: 3,400 +/- 500 g; p < .001), weight/length (-0.4 +/- 1.0 vs. 0.8 +/- 1.1; p = .0001), and length/age z scores (-0.7 +/- 1.0 vs. -0.1 +/- 0.8; p = .007) than children in the CG. Early weaning before 4 months of age was more frequently found in the SG (44.1% vs. 12.1%; p = .04). The logistic regression showed as variables those associated with EBD, that is, birth weight and maternal history of EDB during her infancy (chi(2), p = .0003). Mothers of children in the SG felt that their maternal role was more difficult and less satisfactory than mothers of children in the CG (chi(2), p = .03).

DISCUSSION

EBDs in Chilean infants are observed during the first months of life and are associated with a lower birth weight, shortened exclusive breast-feeding, maternal history of EBD during their infancy, and lower physical growth. Mothers of children with EBD frequently feel that their maternal role is difficult and unsatisfactory.

Height of young men

We analysed the height of young men in Belgium, using 613 257 records of medical examinations made prior to their conscription into the army (about 68% of the male population concerned). All analyses showed very significant associations. Height differed according to the region (-1.24cm in Wallonia, French-speaking and poorer) compared to Flanders (Dutch-speaking and richer), when "age-class" and year are taken into account. The smallest men lived in Hainaut (a deprived area), the tallest ones in Walloon Brabant (wealthy green suburbs of the capital). Height increased across time (+1.11cm, 1978-1990) and with "age-class" (+2.66cm, 18-26years), controlling for other factors. The increase in Brussels stops in 1983, probably due to other socio-demographic evolutions.

Cognitive development of children in poverty with failure to thrive: a prospective study through age 6

BACKGROUND

This study examined the cognitive development of children in poverty with normal growth and those with a history of failure to thrive (FTT) prospectively from infancy through age 6.

METHOD

Participants were 226 low-income infants with normal birthweight and no perinatal complications, congenital problems, or chronic illnesses. One hundred and twenty-eight children experienced FTT and were treated in an interdisciplinary clinic, and 98 had normal growth.

RESULTS

Cognitive development declined in both groups to 1.0-1.5 SD below the norm. Children with FTT had lower cognitive scores than children with adequate growth through age 4, followed by recovery. By ages 5 and 6, there were no differences in cognitive scores based on the children's growth history. Using hierarchical linear modeling, child-centered home environment and small family size were related to better cognitive performance.

CONCLUSIONS

The low scores of both groups point to the need for programs promoting a child-centered home environment.

Simple method for developing percentile growth curves for height and weight

The present paper demonstrates the ease of use of method I by Preece and Baine ([1978] Ann Hum Biol 5:1-24) in generating smoothed growth curves for both height and weight. Using the National Center for Health Statistics (NCHS) growth curve data, smoothed curves were developed and compared to those produced using the least-squares-cubic-spline method. Based on the lower sum of squares and better fit of shape as indicated by residual examination, it was concluded that the method I curve fitting procedure by Preece and Baine ([1978] Ann Hum Biol 5:1-24) fit centile growth curves for height and weight in 2-18-year-old male and female children as well as, if not better than, the least-squares-cubic-spline method used in developing the 1979 NCHS growth curves. Further, as this paper demonstrates, smoothed curves can be generated on a desktop computer using readily available software (the SOLVER function within Microsoft EXCEL).

Behavioral and cognitive status in school-aged children with a history of failure to thrive during early childhood

Twenty-seven school children (aged 8-12 years) earlier diagnosed with nonorganic failure to thrive (FTT) were compared with a normal socioeconomically matched control group (N=17) on current height and weight parameters as well as cognitive, achievement, and behavioral measures from the Child Behavior Checklist (CBCL). The former FTT children were, on average, smaller, less cognitively able, and more behaviorally disturbed than the control children and national normative samples. Sixty percent of former FTT children were below the 20th percentile in height and 48% were below the 20th percentile in weight; 52% had IQs below 80 and 30% had reading standard scores below 80; 48% had clinically adverse attention ratings and 30% had clinically adverse aggression ratings on the CBCL. Within the FTT sample, however, there were no significant associations between current growth measures and cognitive/achievement outcome measures. Mothers' IQs provided the strongest prediction of the FTT children's reading scores. The mothers of the FTT children had not achieved as high levels of education as the mothers of the control children, and more of them were single parents. Early growth problems put children at high risk for multiple adverse sequelae in middle childhood, especially if mothers are poorly educated. Careful ongoing follow-up of such children by pediatricians is encouraged.

Failure-to-thrive, maltreatment and the behavior and development of 6-year-old children from low-income, urban families: a cumulative risk model

OBJECTIVE

A cumulative risk model was used to examine the relationship among failure-to-thrive (FTT), maltreatment, and four aspects of children's development: cognitive performance (standardized testing), adaptive functioning at school, and classroom behavior (teacher report), and behavior at home (maternal report).

METHOD

The sample included 193 6-year-old children and their families, recruited from pediatric clinics serving inner-city, low-income, primarily African-American families, who were part of a longitudinal investigation of child development and maltreatment. Four risk groups were formed based on their growth and maltreatment history: neither FTT nor Maltreatment, FTT Only, Maltreatment Only, and both FTT and Maltreatment. FTT was defined as a deceleration in weight gain (weight-for-age below the 5th percentile) prior to 25 months of age among children born at term with birth weight appropriate for gestational age. Maltreatment was defined as having at least one report to CPS for neglect, physical abuse and/or sexual abuse.

RESULTS

Risk status was negatively associated with each of the four developmental outcomes. Children with a history of both FTT and maltreatment had more behavior problems and worse cognitive performance and school functioning than children with neither risk factor. Children with only one risk factor (either FTT or maltreatment) achieved intermediate scores.

CONCLUSIONS

Findings support a cumulative risk model as being more detrimental to children's development than the presence of a single risk factor alone, consistent with theories linking the accumulation of environmental risks to negative consequences. These results underscore the importance of interventions to prevent both FTT and maltreatment during children's early years.