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Maternal and Child Health Bureau ~ 15

7. Application of principles

Example 1: Child with trisomy 21

AB was followed in an early intervention program from 3 weeks until 41 months of age. Feeding was never a problem, but she was at risk for overweight. At 35 months of age, hypothyroidism was diagnosed, and medication was started.

Her growth was plotted on the CDC charts (head circumference-for-age, weight-for-age, length-for-age, weight-for-length, stature-for-age, and BMI-for-age). Because she was followed past the age of 3 years, both the 0-36 month and the 2-20 years charts were used.

Year 1

Her length-for-age started at about the 25th percentile, and increased to about the 50th percentile at age 13 months.

Weight-for-age was about the 25th percentile.

Weight-for-length increased from about the 25th percentile to about the 50th percentile.

Year 2

Length-for-age decreased from about the 50th percentile at age 13 months to between the 5th and 10th percentiles at age 20 months.

Weight-for-age continued along the 25th percentile.

Weight-for-length continued along the 50th percentile.

Year 3

Although the recommendation is to use the 2-20 year old charts for children over the age of 2 years, the 0-36 month charts were used for AB.

AB was not able to stand unassisted, so length was measured, and length-for-age and weight-for-age were plotted on the appropriate charts.

Length-for-age continued to decrease to slightly below the 5th percentile.

Weight-for-age increased to about the 50th percentile.

Weight-for-length increased to the 95th percentile.

AB's family was interested in how her growth compared to the growth of other children with trisomy 21. The limitations of the condition-specific growth charts were explained:

Small sample size with limited diversity

Reflect growth of children with and without cardiac problems and feeding problems; not necessarily "ideal" growth pattern

The condition-specific growth chart was used to make the following points:

AB seems "short for her age" when compared to typically-developing children; when compared to other children with trisomy 21, she is not "short."

At the age of 35 months, even among children with trisomy 21, AB's weight is at the 95th percentile for age.

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