Assuring Pediatric Nutrition in the Community

FREQUENTLY USED GUIDELINES:
Assessing Nutritional Status - Specialty Growth Charts

Specialty growth charts
Using specialty growth charts
Charts for preterm infants
Charts for children with Down syndrome
Charts for children with cerebral palsy
Charts for children with Turner syndrome
Charts for children with achondroplasia
Charts for children with Willliams syndrome
Charts for children with Prader-Willi syndrome
Charts for children with Noonan syndrome

Are there growth charts for specific conditions or disorders?
Growth data of children with specific conditions have been compiled into charts. These data are typically cross-sectional, and the charts are based on small groups of children.

These charts are useful for comparing individual children to other children with similar diagnoses, but should not be used alone. Rather, data should be plotted on CDC charts, then on specialty charts. Weight for length (or Body Mass Index - BMI) is not available on many of these specialty charts and must be plotted on CDC charts.

It is important to remember that the children used to compile these charts may not have been adequately nourished. Thus, weights may be higher or lower than what is ideal.

How should I use specialty growth charts?
Before you use specialty growth charts, answer these questions:

• Does the child have the same disorder as the children used to compile the chart? (e.g., does she have spastic cerebral palsy—or another type?)
• Why do you want to use the specialty chart?
• Will the comparison help to explain growth trends?
• Was the source of the data reliable?
• How large was the sample?
• Are you using the same measurement technique used to collect data for the charts?

It is critical to use specialty growth charts in conjunction with CDC growth charts.

Are there preterm growth charts?
Several sets of charts are available for use with preterm infants. They attempt to adjust for differences in postnatal and intrauterine growth patterns between term and preterm infants. Weight for length data are not included.

Casey PH, et al. Growth patterns of low birth weight preterm infants: a longitudinal analysis of a large, varied sample, J Pediatr 117: 298, 1990. Length, weight, and head circumference for age are provided for girls and for boys. Further divisions are made between low birth weight (1501-2500 grams) and very low birth weight (< 1500 grams) preterm infants.

Babson SG and Benda GI. Growth graphs for the clinical assessment of infants of varying gestational age. J Pediatr 89: 815, 1976. These charts include cross-sectional data from boys and girls, 26-40 weeks gestational age. Weight, length, and head circumference for age are available.

Gairdner D and Peterson J. Archives of Disease in Childhood 46:783, 1971. Cross-sectional data from 26-40 week gestational age boys and girls and longitudinal data from >4000 term infants were used to compile these charts. Data from boys and girls are combined, and length, weight, and head circumference for age are available.

How long should I use growth charts for preterm infants? The use of CDC growth charts is recommended after an infant is 40 weeks gestation. According to the authors of the CDC growth charts, adjustment for prematurity should continue until age 18 months for head circumference, 21 months for weight, and 36 months for length. A recent report, however suggests that age should be adjusted up to 3 years of age. A note should be made on the growth chart when corrected age is used.

Wang Z and Sauve RS. Assessment of postneonatal growth in VLBW infants: selection of growth references and age adjustment for prematurity. Canadian Journal of Public Health 89: 109-14, 1998.

Are there growth charts for children with Down syndrome? Weight-for-age and stature-for-age charts are available for use with boys and girls with Down syndrome (1 to 36 months, and 2 to 18 years). Because weight gain is usually more rapid than height gain in some children with Down syndrome, overweight is common. It is important to remember that these charts reflect the growth of actual children, not ideal rates of growth. These charts were based on data from children with Down syndrome born between 1960 and 1986 and include children with congenital heart disease. CDC charts should be used to assess weight for length or BMI for age.

Cronk C, et al. Growth charts for children with Down syndrome one month to 18 years of age, Pediatrics 81:102-10. 1988

Are there growth charts for children with cerebral palsy? Charts (weight for age, length for age, weight for length) are available for girls and boys with quadriplegia associated with cerebral palsy. These charts include longitudinal data from 360 children, and should be used only with children who have spastic quadriplegia. Use these charts in conjunction with CDC charts to assess weight for age, length for age, weight for length, and BMI for age.

Krick J et al. Pattern of growth in children with cerebral palsy. J Am Diet Assoc. 1996;96:680.

Are there growth charts for children with Turner syndrome? Data from 366 female patients (2 to 19 years of age) with Turner syndrome (not receiving hormone therapy) were used to compile this height for age chart. CDC charts should be used to assess weight for age and weight for height or BMI for age.

Lyon AJ et al. Growth curve for girls with Turner syndrome. Arch Dis Child 1985;60:932-5.

Are there growth charts for children with achondroplasia?
Charts for children ages 0-17 years with achondroplasia (214 females and 189 males) are available. Height for age, head circumference, and segmental growth are charted. CDC charts should be used to assess weight for age and weight for height or BMI for age.

Horton WA, et al. Standard growth curves for achondroplasia. J Pediatr 1978; 93:435-8.

Are there growth charts for children with Williams syndrome?
Charts for children with Williams syndrome describe the stature for age and weight for age of 61 females and 47 males, ages 0 to 20 years. CDC charts should be used to evaluate weight for height or BMI for age.

Morris CA et al. Natural history of Williams syndrome: physical characteristics. J Pediatr 1988;113:318-26.

Are there growth charts for children with Prader-Willi syndrome?
Charts describing the height for age of 56 boys and 36 girls, ages 3 to 24 years, with Prader-Willi syndrome are available. CDC charts should be used to evaluate weight for height (or BMI for age) and weight for age for all children with Prader-Willi syndrome.

Holm VA. Growth charts for Prader-Willi syndrome. In Greenswag LR and Alexander RC, eds: Management of Prader-Willi Syndrome 2nd ed., New York: Springer-Verlag; 1995.

Are there growth charts for children with Noonan syndrome?
Growth charts are available for 0-24 year old males (n=64) and females (n=48) with Noonan syndrome. Use these charts in conjunction with CDC charts.

Witt DR et al. Growth curves for height in Noonan syndrome. Clinical Genetics 1986; 30:150.