Early growth faltering predicts longitudinal growth failure

Growth monitoring is designed to identify growth disturbances in children, but evidence suggests it may not be used effectively. Growth faltering has negative consequences for the child and the family, and is most amenable to early intervention. The primary objectives of this thesis were to evaluate whether: (1) the infants in this cohort had a similar growth velocity to national normative data; (2) a decline in growth trajectory, identified as a downward movement in z-scores between the three and one-half and seven month time period, can be used to predict later growth faltering; (3) children with larger growth deficits are at greater risk of later growth faltering; and (4) the time period of two-to-four-months is as effective of a predictor as the four-to-six-month period. Longitudinal data from birth to two years of age were analyzed for 1978 healthy, term babies. The outcome variable of wasting was defined as a weight-for-length ratio z-score of ≤ -1.67, with measurements collected at well-child visits (12, 18 and 24 months of age). Results indicated the growth of this cohort was significantly slower in the birth-to-four-month time period and faster in the four-toseven-month period, compared to national growth data. Twenty-four percent of the cohort met the criterion for a case in at least one time period, compared to a national prevalence report of 5.4%. The relative risk for infants with a negative shift in z-scores of greater than -0.85 across the three to seven month time period was 1.275 compared with those without this shift, holding birthweight constant. Risk increased as birthweight decreased. The greater the negative change across the time period, the greater the risk. The change in weight-forage z-score in the four-to-six-month period was an equally robust predictor of growth faltering than was the change in weight for age z-score in the two-to-four-month period. The study results support the hypothesis that a downward shift in growth velocity of this magnitude during early time periods can be used to identify children at-risk of later poor growth. This information can be used to develop research studies and to support providers in decision-making.