Monitoring children's growth

Effect of asthma and its treatment on growth: four year follow up of cohort of children from general practices in Tayside, Scotland

OBJECTIVE

To investigate whether asthma or its treatment impairs children's growth, after allowing for socioeconomic group.

DESIGN

4 year follow up of a cohort of children aged 1-15.

SETTING

12 general practices in the Tayside region of Scotland.

SUBJECTS

3347 children with asthma or features suggestive of asthma registered with the general practices.

MAIN OUTCOME MEASURES

Height and weight standard deviation scores.

RESULTS

Children who lived in areas of social deprivation (assessed by postcode) had lower height and weight than their contemporaries (mean standard deviation score -0.26 (SD 1.02) and -0.18 (1.15) respectively, P < 0.001 for both). Children who were receiving > or = 400 micrograms daily of inhaled steroids and who were attending both hospital and general practice for asthma care had lower height and weight than average, independent of the effect of deprivation (mean standard deviation score -0.62 (1.01), P = 0.002, for height and -0.58 (0.94), P = 0.005, for weight). Children receiving high doses of inhaled corticosteroids also showed lower growth rates (mean change in standard deviation score -0.19 (0.51), P = 0.003). However, no other children with asthma showed growth impairment.

CONCLUSION

Most children with asthma were of normal height and weight and had normal growth rates. However, children receiving high doses of inhaled steroids and requiring both general practice and hospital services had a significant reduction in their stature. This effect was independent from but smaller than the effect of socioeconomic group on stature.

New chart to evaluate weight faltering

A new chart was designed to aid accurate identification of weight faltering and failure to thrive. It provides guidance on the lower limits of expected weight gain for children, whatever their initial centile position. The chart's theoretical basis, the process of its construction, and its evaluation are described in this paper. Evaluation was by a self completion questionnaire, where respondents answered questions about a range of standardised growth patterns, plotted on old and new charts. Forty five health visitors, 28 general practitioner principals and registrars, and nine community paediatricians provided 328 chart ratings. These showed that the new format significantly increased the proportion of correctly rated charts (old: 45 (28%); new: 82 (51%)), with the greatest impact in severe cases. This suggests that the new chart improves the precision of judgments made about weight gain in infancy.

Growth of Pakistani children in relation to the 1990 growth standards

This study was designed to compare the growth of Pakistani schoolchildren in the UK with the 1990 UK growth standards. Measurements of height, weight, and sitting height were performed on 785 Pakistani schoolchildren aged 5-14 years with the mean values for each age and sex being plotted on the UK growth standards. The results were expressed as SD scores relative to the 1990 reference data. The mean height for the boys was only 0.2 SD scores below the mean for the new growth standards with the mean height for the girls being 0.4 SD scores below the mean. The mean values for weight and body mass index were 0.3 and 0.5 SD scores less than the mean for boys and girls respectively. This study demonstrates that the growth of Pakistani schoolchildren in the UK is comparable to the 1990 UK growth standards with only minor differences. It is not safe to assume that short stature or low body weight in a Pakistani child is due to his or her ethnic background.

Growth monitoring with the British 1990 growth reference

AIM

To provide a simple method for assessing centile change based on the British 1990 growth reference.

STATISTICAL METHOD

The change in SD score over a period of time has SD square root of 2(1-r), where r is the correlation between the first and second SD score. This leads to an SD score for centile change.

DATA

Annual height measurements from 2 to 9 years for 318 children from the French longitudinal growth study.

RESULTS

The correlations between heights at different ages are higher for shorter measurement intervals and at older ages. The chance of a child's height centile falling one centile band width is correspondingly smaller for shorter measurement intervals and at older ages. An increase in height measurement error reduces the correlations and dramatically increases the chances of centile crossing.

CONCLUSIONS

Quantitative height monitoring based on centile change is provided for whole year periods between 2 and 9 years of age. Effective monitoring requires the measurement error to be as small as possible.