A TWO YEAR HOSPITAL BASED LONGITUDINAL STUDY OF GROWTH CURVE PATTERNS IN CHILDREN OF UNDER FIVE CLINIC
Dr. Amerja R. Angle*, Dr. N. S. Mahantshetti **
Head Department of Paediatrics, K.L.E.S. Hospital, J.N. Medical College, Belgaum. *, Head Department of Paediatrics, K.L.E.S. Hospital, J.N. Medical College, Belgaum. **
Aims and Objectives
To compare and correlate the pattern of growth curves of weight, length and head circumference with growth curves of Child disease control and prevention programme (CDC), AGGARWALs and A.I.M.S.
Materials and Methods
  • Type of Study: Longitudinal Study
  • Period of Study: 2001 to 2003
  • Study Population: 158 children attending under 5 clinic at K.L.E.S.'s Hospital and M.R.C. Belgaum from 2001 to 2003 in the age group of 0-2 years
Inclusion Criteria
  • Healthy term breast fed babies with no feeding problems
  • Children form birth to two years
  • Children within the radius of 5 km from Belgaum area

Of the 158 patients, 131 patients were included in the study as per the inclusion criteria. Out of these babies males were 85 and females were 46. These parameters were assessed by doctors using the standard techniques. The parameters were then compared with C.D.C. AGGARWALS and A.I.M.S., growth curves at three monthly intervals up till two years.
Observation and Results
Parameters of weight, height and head circumference in our study did not correlate with C.D.C. growth curves and were below 50th percentile of C.D.C. and A.I.M.S. group at all ages.

Though the growth curves for weight in both males and females in our study reached the 50th percentile of C.D.C. curves by six months, there was a sharp dip between 9th and 12th month and also between 18 and 21 st month following which they could reach only the 3rd percentile in males and 5th percentile in females (Fig No.1).

Our length parameters especially in females were in the range of 3rd percentile right from the 3rd month up to 24 months with only one peak, which reached between 25 th percentage to 50th percentile at 12th month of C.D.C. growth curve (Fig No.2).

Head circumference correlated with 50th percentile at six months of age and 75th percentile at 15 months of age following which there was a dip to 3rd percentile at 24 th months of the C.D.C. growth curves (Fig No.3 & 4).

There was a definite correlation between the ages for peaks and dips between the present study and those observed by AIMS group with peak age for dips being 6 to 9 months and 18th to 21st months for weight curves, and 9 to 12 months for the length in males and 12 to 15 months in females and for head circumference between 15 to 24 months in males and 9 to 15th months and 15 to 24 months in females.

The growth curves were far below the growth curves of the AIMS group.

Our growth curves corresponded to 50th percentile and less than that of the AGGARWAL's growth curves up to six months to nine months for all three parameters, and by 24 months they could reach only the 25th percentile of AGGARWAL's growth curve.
Discussion
Growth curve pattern are standardized by C.D.C. (Child Disease Control programme) and have always been used as a reference for growth in children worldwide. However various studies 2 have shown that growth parameters especially weight, length and head circumference differ with different sets of population 3 and also for individual sexes. Hence percentile growth standards for screening children should be derived form the population or subpopulation to which the children belong 4 . This was well substantiated by the study conducted by D.K. Aggarwal, which is the largest Indian Study 5 . The present study was conducted to know the growth curve patterns of the children attending the under five clinic at K.L.E.S. Hospital and M.R.C., Belgaum and to correlate them with C.D.C., AGGARWAL's and A.I.M.S. growth curves.

The study showed that growth parameters were far below the standard laid by C.D.C. growth curves. Even in the first six months, our growth curves were only in the 50th percentile and by 24 months there was a fall up to 3rd percentile in males and 5th percentile in females. When the parameters were compared to the AGGARWAL's growth curve, our growth curves did not correspond to theirs. Though to start with they were in the 75th percentile, they fell to the 25 th percentile by 24 months for all 3 parameters in males and females. We also observed sharp dips in all the curves as early as 6 months for weight, 9 months for length and 12 th month for head circumference. Similar observations were made by A.I.M.S. group.

The factors responsible for the dips were not studied. However this could be attributed to improper weaning practices and increased incidence of infections in this age group. These dips were not observed in AGGARWAL's study. This could be because our study was hospital based. The present study showed that the growth parameters were far below in females as compared to males. This was similar to observations made by C.D.C., AGGARWALs 6 and A.I.M.S 7 . Groups.

This study emphasizes the need to have further studies with a larger population for different sets of population and individual sexes to avoid over diagnosing, malnourishment and stunting, as growth parameters very with difference of population and individual sexes.
Limitations of our Study
  1. Small sample size
  2. As this is Hospital based study it cannot be applied to general population where we have various demographic factors affecting the growth like the socioeconomic status 8 feeding practices, family size etc.
Conclusion
  1. Our growth curves did not match with the growth curves of C.D.C., AGGARWAL's and A.I.M.S., group for all parameters which means growth curve patterns very with different sets of population and also for individual sexes.
  2. Further studies 9 are required to analyze the factors affecting the dips and peaks so that interventions avoid the dips could be undertaken.
  3. Further studies have to be undertaken to correlate the small head circumference with the behavior and cognitive functions of children.
  4. The dips in our growth curves 9th to 12th month could be due to inadequate weaning practices 10 and increased incidence of infections at this age, which necessitates strict monitoring of weaning practices. Aggressive treatment and care of infection to achieve optimal growth.
References :
  1. C.D.C. Growth Charts: United States from URL:http:\\www.cdc.gov.Accessed April 1, 2004.
  2. Tripathi AM, Sen S. Agarwal K.N., Katiyat G.P. Weight and height percentiles for school children. Indian Pediatrics. 1974;11:811-5.
  3. Goldstein H, Tanner JM. Ecological considerations in the creation and the use of child growth standards. Lancet 1980;1:582-5.
  4. Enesbio JS. Nube M. Attainable growth Lancet 1981;2:1223.
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