Sunday, February 19, 2006

Growth Curves

One of our commenters had asked about which growth curve the doctor charted the girls on, so I thought I would write a post about it. Holland and Eden's pediatrician plots them on the growth curve for their actual chronological age. At the last appointment they were 18-months old (January 31st). I wrote that they have hit the charts for head circumference and length, but not in weight.

I printed out the NCHS growth charts, and plotted them according to their adjusted age, which is now 15 months, and the picture isn't much brighter. Holland is really close to the third percentile in weight, but Eden still isn't close. I did all of their measurements at home. Holland weighs 18 pounds 3 ounces, and Eden weighs 16 pounds 12 ounces. At 15 months, 18 pounds 8 ounces would be right at the 3rd percentile, which is the very bottom of the chart. To be on the chart for 18 months (their actual age), they would have to weigh 20 pounds.

Our pediatrician plots the girls according to their actual age because research shows that "85% of premature infants have catch-up growth and land on the regular growth chart by two years of age." This website gives a lot of information about "catch-up" growth and reasons why some babies might not catch up. Of course it's always a good idea to keep genetics in mind! John, at 5'5", is the tallest of his siblings. I am only 5'4". Grandma (John's mom) is 4'11"! We have a 2 1/2 year old neice who weighs 23 pounds and is just barely at the 3rd percentile herself. Of course, we also have a 4 1/2 month old nephew who weighs 22 pounds, but he is a boy so it's different (and he isn't on the charts either!).

I just don't think H and E were destined to be very big girls. That doesn't mean that I'm not pulling my hair out trying to get them to eat. If they were just at the 3rd percentile I wouldn't have to worry so much...The doctor at the developmental clinic at U of M charts the girls on a special chart for Very Low Birth Weight (VLBW) girls. On that chart they don't look so bad. I think Holland was around the 25th percentile, and Eden around the 10th. Of course, the last time that chart was updated was in 1985, and it really isn't considered very valid anymore because a lot has changed in the care and nutrition of VLBW preemies since then. I'm not sure exactly why that doc still uses it. Maybe just to make us feel better:)

I have heard that children with Cerebral Palsy follow a different growth curve than "normal" children, so I also printed out that chart and plotted Eden on it. There we are looking a lot better. Even using her actual age she is just above the 50th percentile in length, and just below the 50th percentile for weight. This chart is for babies with quadriplegia, where all four limbs are affected. Eden has diplegia, where just her lower extremities are affected, but she does have a lot of trunk involvement, so her Physical Therapist thinks it is still fair. It takes a lot more effort, and burns a lot more calories, for Eden to move and get around, so it really makes sense that she will grow more slowly. Especially considering that she doesn't really care about eating!


Unknown said...

That website about catch-up growth is really informative. I have also heard that preemies generally catch up by two years and yet many doctors insist on going by birth age once they hit 12 months. What is up with that? I think they should chart adjusted age until they catch up! Wouldnt that make everyone feel and look better? :P

Mete said...

Oh, the good old growth charts. Our son's pediatrician (and neurologist, actually) look at them differently. They didn't care that he was under the charts for a few years. It was more important to them that he maintained his own curve, staying relatively stable and moving slowly towards the "normal" ranges. They wanted to see that he grew and gained weight at a steady pace, and not in an inconsistent up and down way. If that makes any sense.

The growth charts are good, but they really only give a tiny piece of the picture. You can tell your girls are healthy in so many other ways. I spent years worrying about my son's weight. Suddenly he hit a spurt and flew up to the 75th percentile - and now I wonder if he's going to get too high on the chart! It's hard, but I've come to realize he's going to do EVERYTHING - including growing - at his own rate.

Good luck!!

Anonymous said...

I guess being Malachi's Dad makes these "charts" seem useless! At his 4 month appointment has was off the charts for a 6 month old. By the time we go to his 6 month appointment he probably will not even fit on the paper let alone the chart. I guess as long as all of them are happy and healthy who cares about the charts anyway!

Jill & Terry said...

Your site is very informative. We have been home now for one week from St Joes, NICU. We saw your christmas card you sent your babies are so cute !!!! We already miss the nurses there. We spent 84 days there. If it was not for Amy, Sharon and Chris it would not of been so bearable. Well take care. Here is my Blog: http://HEAVENONE.BLOGSPOT.COM

Kendra Lynn said...

I agree with Nick on the chart thingy...who cares??? As long as they are happy...and they are making progress. I sometimes think that the people who make up those charts may not know exactly what they are talking about anyhow.

Kelsey is OFF THE CHART as well...she's almost as big as Merry...and Merry is a little on the small not that big of a deal...I'm just glad to see the girls getting active and loving life. :)

Love you.


Anonymous said...

Can I come to the foot spa too? Looks like they are having a blast!
Do I need an appointment?
Love, Mamma Jules

Anonymous said...

What happened to H head? The foot spa looks fun.

Anonymous said...

E's bow is cute too where is her ear piece

Billie said...

Holland was pulling to stand by the door wall. She toppled over and scraped her forehead on the pot that the tree is in.

I was holding Eden's headband in my hand. She had just woken up and I wanted to snap a pic so you could see her barette before I put it on.

Anonymous said...

Hi- I figure you have probably read the John-Henry's here website about the 24 weeker. I emailed the mom a long time ago, and she said that it took him past age 5 to hit the charts at all. He's 10 or 11 now and well past the 50th percentile in height and weight, does sports,etc. That gave me peace of mind.

Her advice was for micropreemies like this, look at catch-up at age 3, not 2. Most micropreemies our kids' sizes didn't even survive 7 years ago, so a lot of those types of statements are in need of updating because they pertained to infants in the 30 week+ range.

A long time ago, I did research on the gov. growth charts. I have no idea if this is still the case, but the national norms were based on one town in Ohio where everyone was white and of Germanic descent! My ped. says the same thing as everyone else here- just look for an upward curve.

I was super tall (the tallest kid by far) until 5th grade and then never grew again and now am on the short side. You never know. If you're really worried about weight, get them into cheese, avocados, add butter to food...Could you please write about the sippy cup and weaning from bottles? How are you doing with that? Thanks- E

e3 said...

very informative! my 2 cents for what it's worth - the statistic that "85% of premature infants have catch-up growth and land on the regular growth chart by two years of age" is misleading because it's skewed by the fact that the vast majority of premature births are at 32 weeks and later:

"About 12 percent of babies in the United States are born preterm. Of those, the majority (84 percent) are born between 32 and 36 weeks of gestation. About 10 percent are born between 28 and 31 weeks of gestation, and about 6 percent are born at less than 28 weeks of gestation."

i'm betting that if a well designed study were done solely on infants born less than 28 weeks, the numbers would look quite different.

that said, there's evidence that even the most challenging cases to "catch up" eventually. even bp kids appear to catch up by around age 8:

"In some short term follow up studies infants and young children with BPD were found to be smaller than controls with greater deficits observed in weight than in height.42 43 Growth retardation was reported to be associated with severe and prolonged respiratory dysfunction and growth occurred at an accelerated rate with improvement in respiratory symptoms.42 Another study showed that growth abnormalities might persist into adolescence and adulthood.44 More recently, however, in children aged 8-10 years no consistent differences45 or, after controlling for confounding variables, no significant differences46 were found between those with and without BPD. In addition, schoolchildren who had been infants of very low birth weight were found to be significantly shorter than normal controls.47 Thus, the previously reported poor growth in children with BPD may be related to factors such as birth weight and gestational age rather than to BPD."

we still tend to look at odin on the vlbw charts for the aforementioned reason that it's a bit optimistic to measure kids born less than 28 weeks against their 32+ week cohorts. i use these charts ( scroll down for the premature charts ), but they don't even bother to reference the source data. probably the outdated set from the 80s, making them only slightly useful.

having said all that, i was a micropreemie myself, born in the dark ages, and was already auditioning for lennie in preschool productions of mice and men [ joking ]. so genetics also plays a big [ pun intended ] role.

o.k. maybe that was my 3 cents worth :-)

Anonymous said...

miss hollie, be careful!! you guys look like you're having fun in the sink. i've been thinking of you a lot lately, hope you are well. i miss you guys.
love, lisa

Anonymous said...

Our 31 month old daughter just in the last few months finally made the bottom of the chart for weight! (She has hovered around the 50th percentile in length and head circum.) She was 6 days over her due date birthwise so is not a premie.

At first the doctor was concerned and put her on a high fat diet (this was at about 12 months). You nailed it with genetics though. All of my family tend to have "lighter" babies. Too bad that doesn't carry over into adulthood! :)

Steven Bee