Recognising failure to thrive in early childhood
Article Abstract:
The term failure to thrive describes children who do not gain weight adequately and do not achieve their expected rate of growth. The prevalence of failure to thrive ranges from 5 to 10 percent and is responsible for 1 to 5 percent of hospital admissions of children less than two years of age. Failure to thrive may cause a delay in physical and intellectual development and may be associated with child abuse. A definition of failure to thrive is required to identify children with the condition at an early age. The criteria for diagnosis of failure to thrive should refer to a persistent deviation from the child's expected rate of growth over a specific time period. However, there is no reliable method of estimating an infant's expected growth pattern. The expected growth pattern may be assessed in relation to birth weight, although birth weight is influenced by the characteristics of the mother such as height, age, number of previous pregnancies, nutrition, and smoking and alcohol consumption during pregnancy. The influence of a child's genetic characteristics on the weight of the child is greater at four to eight weeks of age than at birth. The value of weight at birth as compared to weight at four to eight weeks in predicting the child's expected rate of growth was assessed in children diagnosed with failure to thrive. The child's weight at four to eight weeks was better than birth weight in predicting a child's weight at one year. A consistent deviation in values less than the expected rate of weight gain for a month or more was associated with large changes in body measurements in the second year of life. Thus, a method of estimating the expected rate of growth, based on weight at four to eight weeks of age, may be useful in defining failure to thrive. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Archives of Disease in Childhood
Subject: Health
ISSN: 0003-9888
Year: 1990
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Properties and clinical implications of body mass indices
Article Abstract:
Obesity and overweight have a strong influence on the risk of some diseases, and consequently are widely studied. However, the best measure of overweight is not entirely clear. Obviously weight alone is of no value, as a 200 pound six foot man has a different body make-up than a five foot schoolgirl of the same weight. As a result, body mass indices have been used to quantify normal and overweight conditions. The ratio of weight to height has traditionally been popular index; it is far from clear, however, that an individual who is 10 percent taller than another should necessarily weigh exactly 10 percent more. Many research publications use the Quetelet index, which is weight divided by the square of the height; all indices in the medical world are, of course, based on the metric system. Research has shown that the choice of index can bias the results of research on overweight, and that any charts purporting to show 'normal' weights for given heights should be treated with a great deal of caution. This is especially true for children, where the bias introduced by the choice of index changes with age. The authors studied 5,016 Chinese children between 3 and 18 years to determine the best indices of overweight. In order to eliminate bias introduced by physical height as much as possible, they calculated an index of weight divided by height to the pth power, where p is some fraction. This fraction is chosen to give an index which is least affected by height. The results showed that the optimal p varied from less than two to almost three, depending on the age group considered. Therefore, it is clear that no single, simple index will result in a criterion for overweight which is uniformly applicable to everyone. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Archives of Disease in Childhood
Subject: Health
ISSN: 0003-9888
Year: 1990
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Effects of overweight on lung function
Article Abstract:
Spirometric data are indicators of lung function, and include such measurements as breathing volume, or vital capacity, expiratory flow rate, forced expiratory volume, and related measurements. Spirometric data were obtained on 1,586 children ranging in age from 6.5 to 20 years. The data were then correlated with body mass index, also called Quetelet's index, which is the subject's weight divided by the square of the height (metric system, of course). For purposes of analysis, the children were divided into normal and overweight boys and girls. The cutoff point for overweight is, of course, arbitrary, and in this study was defined as being in the top 10 percent of weight for height. A positive correlation was found between the body mass index for normal boys and normal girls, which is different from the case observed in adults, when the correlation is negative. A positive correlation was also observed for overweight girls, but a similar correlation was conspicuously lacking for overweight boys. The observed positive correlations mean only that as body index increases, so does lung function. The lack of correlation for overweight boys reflects the fact that, more so than girls, boys tend to acquire fat in the abdomen, where it directly interferes with respiratory function. The results of the study are also a good illustration of how the body mass index, which does not discriminate between muscle and fat, has entirely different significance when evaluating children rather than adults, and this difference must be considered in any analysis. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Archives of Disease in Childhood
Subject: Health
ISSN: 0003-9888
Year: 1990
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