Growth

Overview

Measuring Techniques

CDC Growth Charts

Growth Grids for CSHCN

Nutrition for CSHCN in Washington State

Community Feeding Teams

Nutrition Focus

Additional Information and Resources

Overview

It is estimated that 14-16% of children have special health care needs. About half of children with special health care needs are at risk for nutrition and feeding problems, and hence are at risk for growth problems. Additionally, the underlying disorder may have associated over/under growth or growth impacts of medication management. All CSHCN should have their growth monitored on a regular basis.

Measuring Techniques

All Children

• MCHB - http://depts.washington.edu/growth
  Topics include: Accurate Measuring—equipment and technique; using the growth charts with various populations such as adolescents, special needs and other
  
  
• A health professional's guide to using growth charts - Pediatrics and Child Health.  2004; 9(3):174-176. www.cps.ca/english/statements/N/NutritionNoteGrowth.htm (see 'Accurate Measurement Equipment and Techniques')

Special Populations:

• Measurement considerations for children with special needs
  http://depts.washington.edu/growth/cshcn/text/page3a.htm
  
  
• Techniques
  http://depts.washington.edu/growth/cshcn/text/page3b.htm

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Centers for Disease Control and Prevention (CDC) Growth Charts – For All Children including CSHCN

CDC Growth Grids: Grids for weight, length, head circumference and BMI

• Growth grids for boys and girls
  
• Separate charts for 0-36 months, 2 to 5 years of age and 2 to 20 years of age
• Set of charts with 3rd, 5th, 10th, 25th, 50th, 75th, 95th, and 97th percentile lines
• Set of charts with 5th, 10th, 25th, 50th, 75th, 95th percentile lines
• Set of charts with 3rd, 10th, 25th, 50th, 75th, and 97th percentile lines
• Charts in Spanish and French

General information on using the (CDC) growth charts

• CDC - Overview of the CDC charts, Use of BMI charts, and recommendations to screen, assess and manage overweight children
  http://www.cdc.gov/nccdphp/dnpa/growthcharts/training/modules/
  module1/text/mainmodules.htm

• MCHB - http://depts.washington.edu/growth/
  • Topics include: Accurate Measuring—equipment and technique; using the growth charts with various populations such as adolescents, special needs and others

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Growth Grids for CSHCN

The current CDC recommendation is to use the CDC growth charts in assessing growth in all children. Condition-specific growth grids should be used in conjunction with general population-based growth grids.

CDC Growth Grids:

• General information on the CDC growth grids (from Child Health Notes)
  
  
• Growth grids for boys and girls - Separate charts for 0-36 months, 2 to 5 years of age and 2 to 20 years of age
  • Set of charts with 3rd, 5th, 10th, 25th, 50th, 75th, 95th, and 97th percentile lines
  • Set of charts with 5th, 10th, 25th, 50th, 75th, 95th percentile lines
  • Set of charts with 3rd, 10th, 25th, 50th, 75th, and 97th percentile lines
    
    
• MCHB - Excellent information specific to growth in CSHCN
  http://depts.washington.edu/growth/cshcn/text/page1a.htm

Condition-Specific Growth Grids:

Condition-specific growth grids are available for a number of conditions with altered growth patterns. Despite the limitations of these special grids, some clinicians may elect to use them, for example to illustrate to families how a specific condition can alter a child's growth potential.  Grids are available for the following conditions:

• Achondroplasia

  http://depts.washington.edu/nutrpeds/fug/growth/specialty.htm
  #achondroplasia

• Cornelia deLange syndrome (Kline, 1993)

  Growth manifestations in the Brachmann-deLange syndrome.
  Kline AD, Barr M, Jackson LG. Am J Med Genet. 47(7):1042-1049, 1993.

• Low Birth Weight Infants
• LBW/ELBW Growth Grids (IHDP and NICHD grids)- http://www.medicalhome.org/diagnoses/lbw_ot_gg.cfm
• Using Corrected age http://depts.washington.edu/growth/cshcn/text/page4a.htm
• Information on growth in infancy and early childhood http://www.medicalhome.org/diagnoses/lbw_pr_g.cfm
  
• Marfan syndrome

  Pyeritz RE. In:  Endocrine genetics and genetics of growth. Papadatas CJ, Bartsocas CS.  Eds. 1985.

• Noonan syndrome

  http://depts.washington.edu/nutrpeds/fug/growth/specialty.htm#noonan

• Prader-Willi syndrome

  http://depts.washington.edu/nutrpeds/fug/growth/specialty.htm#prader

• Trisomy 21 (Down syndrome)
  • Growth grids
  • Growth in Down syndrome

• Turner syndrome

  http://depts.washington.edu/nutrpeds/fug/growth/specialty.htm#turner

• Williams syndrome

  http://depts.washington.edu/nutrpeds/fug/growth/specialty.htm#williams

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Nutrition for CSHCN in Washington State

http://depts.washington.edu/cshcnnut/

Nutrition for Children with Special Health Care Needs in Washington State is a collaboration between the Children with Special Health Care Needs Program in the Department of Health, and the Center on Human Development and Disability at the University of Washington in Seattle, WA.

The information at this site is meant to support nutrition services for children with special health care needs and their families in Washington State.  Others outside the state may also find the information helpful. Registered dietitians, nurses, primary care providers, occupational therapists, physical therapists, speech therapists, educators, social workers, and others working with the pediatric special needs population will find useful information, available services, resources, publications, and links to related Web sites.

Special information:

• Failure to Thrive and Growth Failure
• Assessing Dietary Intake
• Assessing Nutritional Care of Preterm Infants
• Overweight in Special Needs Children
• Common Drug - Nutrient Interactions
• Development: Assessment of Feeding Skills

New - Updated Edition of Nutrition Intervention for Children with Special Health Care Need, 3rd ed, April 2010. Yang Y, Lucas B, Feucht S, editors.  Washington State Department of Health, Olympia WA. 425 pages including glossary and index; 23 chapters; 21 appendices.

http://depts.washington.edu/cshcnnut/resources/cshcn.html#nut_interv

This book addresses the growth, nutrition, and feeding of children with or at increased risk for a broad range of chronic illnesses or conditions who require intervention beyond basic, routine, pediatric care. The new edition of the booklet, published by the Washington State Department of Health, is divided into three sections and includes new chapters on breastfeeding, physical activity, and autism spectrum disorders. Each chapter contains intervention strategies, outcomes, and references. Additional tools are included in the appendix.  

• Section 1 outlines procedures for nutrition screening and assessment and development of a nutrition intervention care plan.
• Section 2 addresses nutrition-related problems across a wide range of diagnoses.
• Section 3 examines nutrition management related to specific diseases and disorders that have strong nutrition components.

Registered Dietitians who are members of the CSHCN Nutrition Network and each WA Community Feeding Team have received copies.

The book can be downloaded and free CD copies ordered at this DOH website:

http://here.doh.wa.gov/materials/nutrition-interventions 

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Community Feeding Teams

http://depts.washington.edu/cshcnnut/feeding/locating.html

The Washington State Community Feeding Teams provide an interdisciplinary approach to address feeding/nutrition concerns for children with special health care needs in a comprehensive, cost-effective manner. They work directly with families to help parents/caregivers resolve important issues related to feeding and nutrition. The team approach can help a child and family avoid duplication of services, allow all issues around food and feeding to be assessed by one team, and assist with identification of subsequent service/therapy needs.

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Nutrition Focus

Subscription information and ordering back issues - http://depts.washington.edu/chdd/ucedd/CO/Nutrifocus.pdf

Nutrition Focus is a bimonthly newsletter that focuses on nutritional challenges of children with special health care needs and their families. The newsletter is written for health care providers and others who serve children with special health care needs. The goal of the newsletter is to increase awareness of nutrition and share useful assessment and intervention strategies within the health care community.

Each article highlights a specific disorder or nutrition concern and offers practical suggestions and guidance for families and health care professionals.  Examples of topics covered:

• Nutrition issues for the premture infant after hospital discharge
• Energy/protein for CSHCN
• Nutrition concerns of children with autism specturm disorders
• ADHD and nutrition issues
• Tube feeding update
• Complementary nutrition therapies in pediatrics
• Nutrition services for children with special health care needs - What are the cost considerations?
• Nutrition concerns in children with Treacher-Collins Syndrome
• And MANY MORE!

It is estimated that 40% of all children with special health care needs may be at risk for nutrition problems. If these problems are addressed early by qualified health professionals, the outcomes are appropriate growth, improved health status, fewer hospitalizations and cost savings in overall health care expenditures. Nutrition Focus is a vehicle for disseminating timely, evidence-based and practical information that allows health care providers to effectively address the nutritional issues of children with special health care needs.

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Additional Information and Resources

• Getting Connected
• Bright Futures in Practice: Nutrition (2002)
• Feeding Development and Behavior

= Adobe Acrobat file format. Help with PDF

Growth Section:

Edited by Katherine TeKolste, MD, FAAP

Developmental Pediatrician; MHLN Medical Consultant

Reviewed by Cristine Trahms, MS, RD

Head, Nutrition Section, Center on Human Development and Disability;

PKU/Biochemical Genetics Clinics

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