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Training Module: Children with special health care needs

Growth patterns of children with special health care needs
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2. Growth patterns of children with special health care needs

2.2 Conditions that have the potential to alter growth

While some conditions alter growth potential, other conditions have the potential to alter growth. These conditions may have associated biological or environmental factors that can influence a child's growth.

For these conditions, there is no clear rationale for the development of reference data for growth because there is no identifiable alteration in the genetic potential for growth in these conditions.

Three conditions that have the potential to alter growth are:

bullet neurologic disorders that impair ambulation
bullet low birth weight
bullet feeding problems

Neurologic disorders that impair ambulation
Children who are non-ambulatory due to neurological conditions such as severe cerebral palsy or neural tube defects such as spina bifida (myelomeningocele, do not grow normally. This is thought to be due to a lack of weight-bearing which normally provides the physical stress on the long bones of the leg required to stimulate bone growth (Stevenson, Roberts, Vogtle, 1995).

Some children with neurologic conditions affecting ambulation also have problems with feeding, which can be an additional factor influencing growth (Stevenson, 1995). This is discussed later in this section.

Low birth weight
Babies born weighing 1500-2500 grams have a low birth weight. Babies born weighing less than 1500 grams have a very low birth weight. They may or may not have intrauterine growth retardation (IUGR), depending on their gestational age.

bullet If an infant is born prematurely, the low weight may be appropriate for gestational age (AGA) and the infant may not have IUGR.
bullet On the other hand, an infant may be born at term weighing less than 2500 grams; that infant is small for gestational age (SGA) and has IUGR.

Depending on the timing, duration and severity of the nutritional insult, as well as the success of postnatal nutrition intervention, the growth potential of children born SGA and who have IUGR may be permanently adversely affected (Anderson, 1999).

Low birth weight infants (infants weighing 1500-2500 grams at birth) are included in the CDC reference population, so it is appropriate to use CDC growth charts with these infants.

The CDC growth charts do not include growth data from very low birth weight (VLBW) infants (infants weighing less than 1500 grams at birth). For this reason, it may not be appropriate to use the CDC growth charts to assess the growth of VLBW infants. Alternate charts are available, based on data from two major studies:

bullet National Institute of Child Health and Human Development Neonatal Research Network centers (Ehrenkranz, 1999) extend to 3 or 4 months of age
bullet Infant Health and Development Program (IHDP) (Guo et al., 1996 and 1997; Roche, et al., 1997) extend to age 36 months

More information about the use of the CDC growth charts with VLBW infants can be found in the module, Overview of the CDC Growth Charts.

TERMS USED TO DESCRIBE PREMATURITY AND BIRTHWEIGHT
Term Used to describe
Premature Infants born before 37 weeks gestation
Low birth weight (LBW) Infants weighing less than 2500 g at birth
Very low birth weight (VLBW) Infants weighing less than 1500 g at birth
Extremely low birth weight (ELBW) Infants weighing less than 1000 g at birth
Intrauterine growth retardation (IUGR) Growth of the fetus that is delayed related to gestational age
Small for gestational age (SGA) Infants whose birthweights are less than expected for their gestational age; <10th percentile is often used
Gestational age The age of a fetus or newborn, usually stated in weeks from the first day of the mother's last menstrual period
Chronologic age The age of an infant stated as the amount of time since birth
Corrected age The age of an infant from birth, minus the number of weeks premature
Appropriate for gestational age (AGA) Infants whose birthweights are as expected for their gestational age; 10th - 90th percentile is often used
Large for gestational age (LGA) Infants whose birthweights are greater expected for their gestational age; above the 90th percentile is often used


Feeding problems

Problems with feeding that interfere with an adequate nutrient intake have obvious effects on a child's growth.

Children with neurodevelopmental problems, such as cerebral palsy, often have feeding problems due to structural abnormalities of the oral area (teeth, gums, jaw) or oral-motor dysfunction due to abnormal tone or reflexes affecting their ability to close their lips, suck, swallow or chew (Cloud, 1997; Stevenson, 1995).

Children with neural tube defects such as spina bifida often have the Arnold Chiari malformation of the brain, which makes swallowing difficult (Ekvall, 1993).

Problems with gastroesophageal reflux (GER) can contribute to problems with feeding as well. Many children with neurodevelopmental problems have GER (Cloud, 1997; Stevenson, 1995).

Tactile sensitivity or sensory defensiveness, common among children with cerebral palsy, autism, and spina bifida may cause a child to avoid putting things in his/her mouth (Cloud, 1997; Stevenson, 1995).

Without intervention, these difficulties can lead to inadequate food intake and slowed growth.

Children may also have feeding problems as a result of behavioral or emotional issues, many of which result from relational difficulties early in life. Other feeding problems may be the result of complex perinatal medical interventions that center around feeding or around the mouth, making subsequent oral experiences, including feeding, unpleasant (Cloud, 1997).


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