Growth patterns and nutritional factors associated with increased head circumference at 18 months in normally...

To identify patterns of growth, nutrition practices, and feeding behaviors associated with normal Denver II developmental screening results at 18 months of age.

A retrospective review of hospital medical charts was conducted to collect discharge diagnosis and dietary data. Developmental clinic charts were reviewed to collect growth and diet data, Denver II results, and medical data from 4-, 9-, and 18-month visits.

Twenty-eight children were identified from a review of developmental clinic records in a midwestern children's hospital. Criteria were single or twin birth, birth weight of 2,000 g or less, follow up at the hospital developmental clinic, and completion of 3 screening visits.

National standards were used to calculate z scores. Patterns of growth were analyzed using analysis of variance. Stepwise forward linear regression analysis was done to construct a model predicting head circumference at 18 months of age.

Significant catch-up growth (P = .0006) occurred as length z score increased from -0.87 at 4 months of age to -0.45 at 18 months. A regression model predicting head circumference at age 18 months was developed that included nutrition and growth variables such as head circumference at 9 months, type of parenteral amino acids administered in the hospital, z score of weight at 4 months' adjusted age, and time of first enteral feeding.

Interventions designed to support breast-feeding in the hospital and at home are indicated as is increased emphasis on monitoring growth. Delays in growth need to be treated aggressively; for example, nutrition interventions should begin by the age of 4 months if weight gain is not appropriate.