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Widespread growth retardation and variable growth recovery in foster children in the first year after initial
D T Wyatt1, M D Simms, S M Horwitz
1Department of Pediatrics, Medical College of Wisconsin, Milwaukee, USA.
Insights
Children in foster care often experience growth deficits, but nearly half show catch-up growth within a year. Initial height doesn't predict future growth, highlighting the need for careful monitoring beyond simple screening for growth retardation.
Area of Science:
- Pediatrics
- Child Development
- Growth Monitoring
Background:
- Children entering foster care may have experienced prior growth retardation.
- Assessing growth patterns is crucial for understanding child well-being in foster care.
Purpose of the Study:
- To determine children's growth patterns during their first year in foster care.
- To evaluate catch-up growth and initial height percentile as indicators of prior growth retardation.
Main Methods:
- Inception cohort study of 45 children aged 1.5 to 6.0 years.
- Measured height, weight, and growth velocity z scores over one year post-placement.
- Analyzed growth patterns including catch-up, stable, and poor growth.
Main Results:
- Children showed an initial height deficit but achieved average height by year-end.
- Nearly half (47%) exhibited catch-up growth, while 18% showed continued decline.
- Initial height percentile did not predict catch-up growth or future growth velocity.
Conclusions:
- Significant catch-up growth in foster care children suggests prior growth failure.
- Simple height screening may miss children needing intervention.
- A notable percentage of children experienced continued growth decline post-placement.
Objectives:
To determine children's growth patterns in the first year of foster care placement and to compare catch-up growth with initial height percentile as indicators of prior growth retardation.
Design:
Inception cohort.
Subjects:
Forty-five children aged 1 1/2 to 6.0 years in their first year of foster care.
Setting:
Urban, community-based primary care center.
Main Outcome Measures:
Height, weight, weight-for-height, and annual growth velocity z scores 1 year after placement.
Results:
The group entered foster care with an overall height deficit (height z = -0.21), grew at an above-average rate (velocity z = +0.33), and eliminated the height deficit by the end of the year (height z = -0.02; P < .05). Weight increased (baseline weight z = -0.16; year-end weight z = +0.35) and correlated with height z change (r = 0.385, P = .009). Weight for expected weight-for-height-age was above average and did not change (baseline weight for expected weight-for-height-age z = +0.30; year-end weight for expected weight-for-height-age z = +0.40). Baseline age correlated with velocity z (r = .413, P = .005) but not with change in height z. Baseline height z did not correlate with either velocity z or change in height z. Three patterns of growth were seen: 21 (47%) showed catch-up growth (height velocity z = 1.34; gain in height z = +0.61); 16 (36%) showed stable growth; and 8 (18%) showed poor growth (height velocity z = -1.49; decrease in height z = -0.49).
Conclusions:
Almost half of the children showed significant catch-up growth in the first year after foster care placement, indicating probable prior growth failure. Initial height was not predictive of future growth, and simple screening (such as height less than the fifth percentile) would have missed the majority of children who showed catch-up growth. A substantial minority (18%) continued to decline across height percentiles after placement. The initial and subsequent growth failure and catch-up growth in this population did not appear to be related to nutritional changes.