It is estimated that 14-16% of children have special health care needs. About half of the children with special health care needs are at risk for nutrition and feeding problems, and hence are at risks for growth problems

Additionally, the underlying problems may be associated with over/under growth and these can have impacts on the medical management or intervention needed.

A variety of health conditions affect growth status and there are specialized charts that may be considered for use with children affected by these conditions. These specialized growth charts provide useful growth references, but may have some limitations. Generally, they are developed from relatively small homogenous sample population and the data used to develop the charts may be obtained by inconsistent measuring techniques.

Growth is influenced by many factors

• Genetic influences : genetic disorders/ chromosomal disorders
• Environmental influences : nutrition intake/ social economic status
• Biological influences : Disease/ medication/ impaired motor skills

Conditions that alter growth

Chromosomal disorders

Some conditions, which involve abnormalities at the chromosomal level, are associated with growth patterns that differ. It is assumed that these differing growth patterns are due to the altered growth potential stemming from the underlying chromosomal abnormality.

Examples of conditions related to chromosomal aberrations include Prader-Willi syndrome, Cornelia de Lange syndrome, Turner syndrome, and trisomy 21 (Down syndrome)



Genetic disorders

For children with genetic disorders, such as metabolic disorder, there is a potential for altered growth because the affected metabolic pathways are involved in producing energy or building body tissue.

Examples of conditions related to genetic disorders are endocrine diseases (growth hormone deficiency, hypothyroidism), bone disorders (achondroplasia, skeletal dysplasia)



Conditions that have the potential to alter growth

These are conditions which have the potential to alter growth, and can be biological or environmental factors that can influence the growth of a child. For these conditions, there is no clear rationale for the development of reference data for growth because there is identifiable alteration.

Three conditions that have the potential to alter growth



Neurological disorders that impair ambulation

Examples: cerebral palsy, spina bifida




Low birth weight

This could be due to pre-term birth and also be due to intrauterine growth retardation (IUGR)




Feeding problems

Children with neurological problems mentioned above, problems with gastro esophageal reflux, tactile sensitivity or sensory defensiveness due to other medical conditions.





Condition-specific growth charts

Growth charts for a number of chromosomal disorders have been made. They include the following:



Trisomy 21 (Down syndrome)

Prader- Willi syndrome

Williams syndrome

Cornelia deLange syndrome

Turner syndrome

Rubinstein-Taybi syndrome

Marfan syndrome

Achondroplasia





Limitations of specialized Growth charts

The usefulness of specialized growth charts is limited by a number of factors. They are:



The sample size used to develop these charts are small

The data does not reflect racial, ethnic or geographic diversity

Old data have been used to construct some charts

The populations used for the collection of the sample data are not clearly defined, example: well-nourished children, low social economic group etc. are not taken into account.

The techniques used for measuring the children are not clearly defined, and or, there are restrictions in the measurement of children with certain afflictions.

Secondary medical conditions may be present, which can also affect the growth and these are not taken into consideration.