Widespread growth retardation and variable growth recovery in foster children in the first year after initial placement
D. T. Wyatt, M. D. Simms and S. M. Horwitz
Department of Pediatrics, Medical College of Wisconsin, Milwaukee, USA.
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.
