Specialty Growth Charts - continued

The charts based on the growth of children with Down syndrome (trisomy 21) provide some examples of these limitations. For these reasons (and others), the American Academy of Pediatrics recommends that clinicians NOT use the Down syndrome charts because they do not reflect the current population and body proportion.

The clinician using the specialty charts should be aware of potential limitiations to specialty charts. Limitations to previously used charts for Down syndrome are included as an example:

• The children in the sample were of limited diversity with respect to race, ethnicity, and the geographic location of their residence

• The nutritional status of the children in the sample was not assessed, so it is difficult to ascertain whether or not the data represent a well-nourished group of children or reflect problems with nutritional status

• The existence of secondary medical conditions affecting growth (congenital heart disease, which affects about 40% of children with Down syndrome, and feeding problems, which are present in up to 80% of children with Down syndrome) was not considered in developing the reference data

Growth charts for children with cerebral palsy acknowledge the effect that different disease severities and feeding modalities can have on growth. One group constructed charts based on data from almost 25,000 children with cerebral palsy in California. Sets of charts are available for different groups:

1. Walks well alone ≥20 feet, balances well
2. Walks with support or unsteadily alone ≥10 feet, but does not walk alone or balance well
3. Crawls, creeps, or scoots, does not walk
4. Does not walk, crawl, creep, or scoot; does not feed self, is not gastrostomy tube fed
5. As Group 4, but gastrostomy tube fed

Limitations include the use of measurements reported in medical records (not a standardized measurement technique).