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David T. Wyatt, MD; Mark D. Simms, MD, MPH; Sarah M. Horwitz, PhD

Arch Pediatr Adolesc Med. 1997;151(8):813-816.

Abstract
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 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 aboveaverage 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.

Arch Pediatr Adolesc Med. 1997;151:813-816

Author Affiliations
From the Department of Pediatrics, Medical College of Wisconsin, Milwaukee (Drs Wyatt and Simms); and Department of Epidemiology and Public Health, Yale University, New Haven, Conn (Dr Horwitz).

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