Height and body proportions in child abuse

Sitting Height to Standing Height Ratio Reference Charts for Children in the United States

OBJECTIVE

To create reference charts for sitting height to standing height ratio (SitHt/Ht) for children in the US, and to describe the trajectory of SitHt/Ht during puberty.

STUDY DESIGN

This was a cross-sectional study using data from the 1988-1994 National Health and Nutrition Examination Survey III, a strategic random sample of the US population. Comparison between non-Hispanic White (NHW), non-Hispanic Black (NHB) and Mexican American groups was performed by ANOVA to determine if a single population reference chart could be used. ANOVA was used to compare SitHt/Ht in pre-, early, and late puberty.

RESULTS

NHANES III recorded sitting height and standing height measurements in 9569 children aged 2-18 years of NHW (n = 2715), NHB (n = 3336), and Mexican American (n = 3518) ancestry. NHB children had lower SitHt/Ht than NHW and Mexican American children throughout childhood (P < .001). In both sexes, the SitHt/Ht decreased from prepuberty to early puberty and increased in late puberty. Sex-specific percentile charts of SitHt/Ht vs age were generated for NHB and for NHW and Mexican American youth combined.

CONCLUSIONS

SitHt/Ht assessment can detect disproportionate short stature in children with skeletal dysplasia, but age-, sex-, and population-specific reference charts are required to interpret this measurement. NHB children in the US have significantly lower SitHt/Ht than other children, which adds complexity to interpretation. We recommend the use of standardized ancestry-specific reference charts in screening for skeletal dysplasias and have developed such charts in this study.

A Link between Nutritional and Growth States in Pediatric Patients with Functional Gastrointestinal Disorders

OBJECTIVE

To investigate nutritional status and growth status of pediatric patients with functional gastrointestinal disorders (FGIDs) and to examine the relationship between nutritional status and linear growth in these children.

STUDY DESIGN

In total, 102 pediatric patients diagnosed with functional constipation (FC), irritable bowel syndrome (IBS), or functional abdominal pain (FAP) in years 2013-2015 were subjected to anthropometric measurements. Anthropometry comprised body height, leg and trunk lengths, body weight, mid-upper arm circumference, and 3 skinfold thicknesses. Body fat percentage was obtained with bioelectrical impedance analysis. Indices of the nutritional status and body proportions were calculated and adjusted for age and sex.

RESULTS

Excessive body weight and excessive fatness were the most common in children with IBS. Being underweight was most common in children with FAP, but fat deficiency was similarly frequent in the FAP and in FC groups. Short stature was the most common in children with FC. Children with IBS were the best nourished and the tallest for age and sex due to increased trunk length. Body height and linear body proportions adjusted for age and sex were positively associated with body weight and body fatness in the total sample.

CONCLUSIONS

Children with FGIDs present various linear growth abnormalities that are associated with body weight and body fatness. Although excessive body weight and body fat are common in children with IBS, pediatricians should be aware of the risk of malnutrition in children with other FGIDs.

Height deficit in early adulthood following substantiated childhood maltreatment: A birth cohort study

Early life stress including childhood maltreatment has been associated with reduced head circumference and/or brain size, cognitive, and academic deficits in children and adolescents. However, little is known about the effect of childhood maltreatment on height, especially in early adulthood. This study was designed to examine the association between confirmed cases of multiple or subtypes of childhood maltreatment and stunted growth in young adulthood controlling for perinatal and familial confounding factors. A total of 2661 (48.4% female) young adults from the Mater Hospital-University Study of Pregnancy (MUSP) had data on standardised height-for-age score measurement as part of physical assessment at the 21-year follow-up. Prospectively substantiated cases of childhood maltreatment, 0-14 years of age, were linked to the MUSP dataset. Ethical approval was obtained from the Human Ethics Review Committee of The University of Queensland and the Mater Hospital. Multiple regression analyses were performed to determine the effects of childhood maltreatment on height in young adults. Childhood physical or emotional abuse and neglect were significantly associated with a deficit in height in young adulthood after controlling for perinatal and familial confounders. Multiple incidents of childhood maltreatment also were associated with a deficit in height.

Sexual dimorphism in growth in the relative length of the forearm and relative knee height during adolescence

There are numerous studies concerning sexual dimorphism in body proportions, but only a few have investigated growth in the relative length of particular segments of the upper and lower limbs during adolescence. The aim of the study is an assessment of sex differences of longitudinal growth in the relative length of the forearm and knee height among adolescents. Sample involved 121 boys and 111 girls, participants of the Wroclaw Growth Study, examined annually between 8 and 18 years of age. Sexual dimorphism in six ratios: forearm length and knee height relatively to: trunk, height, and limb length were analyzed using a two-way analysis of variance with repeated measurements. The sex and age relative to an estimate of maturity timing (3 years before, and after age class at peak height velocity [PHV]) were independent variables. All of the ratios showed significant sex differences in interaction with age relative to age at PHV. The relative length of the forearm, in boys, did not change significantly with the years relative to age at PHV, whereas in girls, was the lowest in the two first age classes and afterward significantly increased just 1 year before and during the adolescent growth spurt, remaining unchanged in further age classes. For relative knee height no clear pattern for sex differences was noticed. It is proposed that relatively longer forearms, particularly in relation to the trunk in girls, could have evolved as an adaptation to more efficient infant carrying and protection during breastfeeding.

Case report: Forensic anthropological assessment in a suspected case of child abuse from South Africa

Not many case reports of suspected child abuse as assessed solely on skeletal remains are available. Forensic anthropologists have intimate knowledge of normal skeletal anatomy, bone trauma and processes of healing of bone and may therefore be of help in suspected cases of child abuse. Patterns of trauma in juvenile skeletal remains which are suggestive of abuse include fractures in different phases of healing, multiple fractures, typical fractures on ribs and long bones and severe, complicated cranial fractures. The aim of this paper is to report on the findings of the analysis of the skeletal remains of a 3.5 years old boy. Forensic pathological examination indicated that the boy had died from a massive cranial fracture, with multiple injuries present to the rest of the body. After the body had been buried for some time, it was exhumed and we were requested to look for signs of chronic, long-term abuse. Findings included a massive cranial fracture, another fracture in the roof of the orbit, two areas of non-specific subperiosteal bone growth and several untreated carious teeth. No clear healed fracture could be found, except for a possible healed cranial base fracture which stretched transversely across the petrosal bone. This area showed signs of recent bone activity. The court decided that this was not enough evidence of chronic abuse and found the accused guilty of murder but not of chronic child abuse. This case illustrates the difficulty to obtain clear signs of chronic injury on juvenile remains.

Growth and nutritional status in children and adolescents with cystic fibrosis

BACKGROUND

Growth retardation, delayed puberty and malnutrition are frequently observed in children suffering from cystic fibrosis.

AIM

The aim of this study was to estimate growth and nutritional status in children with cystic fibrosis on the basis of body proportions and body mass index.

SUBJECTS AND METHODS

Anthropometric data were collected from the medical histories of 62 patients treated in three cystic fibrosis treatment centers in Poland. Anthropometric parameters were expressed in terms of standard deviations away from age-specific and sex-specific reference means reported for the population of Poland. Two-way analysis of variance was used to determine whether the type of cystic fibrosis transmembrane conductance regulator (CFTR) mutation is correlated with age at the time of diagnosis and with body proportions.

RESULTS

The type of mutation was significantly correlated with height, weight and transverse chest width. Growth retardation was greater in subjects diagnosed before they were 3 years old than in subjects diagnosed later. The children had infantile body proportions. Their legs were short and their trunks were long in comparison to their height. Almost 40% of the subjects suffered from malnourishment.

CONCLUSION

Further study is needed to determine how growth in children with cystic fibrosis is affected by clinical practice and socio-economic factors.

Nationwide age references for sitting height, leg length, and sitting height/height ratio, and their diagnostic value for disproportionate growth disorders

AIMS

To obtain age references for sitting height (SH), leg length (LL), and SH/H ratio in the Netherlands; to evaluate how SH standard deviation score (SDS), LL SDS, SH/H SDS, and SH/LL SDS are related to height SDS; and to study the usefulness of height corrected SH/H cut-off lines to detect Marfan syndrome and hypochondroplasia.

METHODS

Cross-sectional data on height and sitting height were collected from 14,500 children of Dutch origin in the age range 0-21 years. Reference SD charts were constructed by the LMS method. Correlations were analysed in three age groups. SH/H data from patients with Marfan syndrome and genetically confirmed hypochondroplasia were compared with height corrected SH/H references.

RESULTS

A positive association was observed between H SDS, SH SDS, and LL SDS in all age groups. There was a negative correlation between SH/H SDS and height SDS. In short children with a height SDS <-2 SDS, a cut-off limit of +2.5 SD leads to a more acceptable percentage of false positive results. In exceptionally tall children, a cut-off limit of -2.2 SDS can be used. Alternatively, a nomogram of SH/H SDS versus H SDS can be helpful. The sensitivity of the height corrected cut-off lines for hypochondroplasia was 80% and for Marfan syndrome only 30%.

CONCLUSIONS

In exceptionally short or tall children, the dependency of the SH/H ratio (SDS) on height SDS has to be taken into consideration in the evaluation of body proportions. The sensitivity of the cut-off lines for hypochondroplasia is fair.

Effect of familial distress on growth and maturation of girls: a longitudinal study

A longitudinal sample of girls (N = 271), all born during the same year, were examined at yearly intervals during a period of 11 (N = 174) or 8 years (N = 97). The data gathered included the following: age at menarche, anthropometric dimensions, skeletal maturity scores with the TW2 method, and questionnaire information about the present and past socioeconomic situation and family dynamics. The girls were divided into two groups. Group A (N = 207) comprised girls who lived in families free of strong traumatic events. Group B (N = 64) included girls whose family dysfunction exposed them to prolonged distress. Two anthropometric dimensions were central to the analysis: height and subischial leg length. Age at attaining four different maturity stages were also used: age at menarche, age at a Carpal score of 1,000, age at the RUS score of 1,000, and age at the total bone score of 995. The mean age at menarche of girls from group A was 13.3 years and that for girls in group B was 12.9 (F = 6.295, P < 0.01). There was no correlation between age and height at final stages of skeletal maturation, i.e., at a total bone score of 995 or a RUS score of 1,000 in group A. There was no significant difference in height between girls whose skeletal maturity was completed early and those in whom it was completed late. Girls from group B, whose skeletal maturity was reached earlier, were shorter than those who grew until a later age. In group B, the stature was positively correlated with the age at which the late stages of skeletal maturation was attained (r = 0.26 at a RUS score of 1,000 and r = 0.28 at a total bone score of 995, P < 0.05). Regardless of the ages at which any of the four maturity levels were reached by girls from group A, they were, on average, taller than those from group B at the same maturity level. Only at a RUS score of 1,000, when the sample size is reduced, the difference was not significant. The results show that girls exposed to familial distress are more likely to have an early puberty, which is associated with short final stature.

Growth, puberty and obesity after treatment for leukaemia

Final height, body proportions, pubertal growth and body mass index were studied retrospectively in 142 survivors of acute lymphoblastic leukaemia (ALL). Treatment consisted of combination chemotherapy and cranial irradiation (18 or 24 Gy). Significant standing height loss and disproportion, with a relatively short back, was seen in both radiation dose groups. Girls were more severely affected than boys. Pubertal growth was adversely affected, with a reduction in peak height velocity in both sexes. Puberty occurred early in girls but at the normal time in boys. Nearly half the group were obese at final height, with no significant difference in incidence between the sexes. The relative roles of cranial irradiation and chemotherapy in the disturbance of growth, puberty and body composition observed in survivors of childhood ALL remain unclear. The aetiology is almost certainly multifactorial, with radiation-induced growth hormone insufficiency, early puberty, steroids and chemotherapy all having a role.

Disproportionate short stature after cranial irradiation and combination chemotherapy for leukaemia

The effect of combination chemotherapy and cranial irradiation on final height and body proportions was retrospectively examined in a cohort of 142 children treated for acute lymphoblastic leukaemia (ALL). Eighty four children (48 girls, 36 boys) received 24 Gy cranial irradiation and 58 (35 girls, 23 boys) 18 Gy. None had received testicular or spinal irradiation. A significant reduction in standing height SD score from diagnosis to final height was seen in all groups. Of the 109 children in whom sitting height measurements were available, 88 (81%) had relatively shorter backs than legs and in 25 (23%) this disproportion was of a marked degree. After mathematical correction for sitting height loss there was no longer a significant reduction in standing height SD score at final height in all except the 24 Gy group of girls. These data suggest that disproportion is a common finding after treatment for ALL and that, at least in some children, much if not all of the height loss seen is due to a reduction in sitting height. Possible explanations for this disproportion include a disturbance of puberty or an effect of chemotherapy on spinal growth, or both.