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INTRODUCTION
A childs growth can be compared with that of his or her peers
by referring to the norm on an appropriate growth chart. More
important, the longitudinal measurements of a childs growth are
a dynamic statement of his or her general condition or health.
Tanner (1) has proposed that children be measured accurately
to identify individuals or groups of individuals within a community who require special care, to identify illnesses that influence
growth, or to determine an ill childs response to therapy. The
linear growth of a child-adolescent athlete may also reflect the adequacy of energy intake for a particular training regimen. Measurement of growth may also be used as an index of the general
health and nutrition of a population or subpopulation of children.
GROWTH MEASUREMENTS
The growth of children should be measured periodically and
accurately. Two common devices are adequate for such measurements and were described by Rogol and Lawton (2).
Neonates and infants
Small inaccuracies in length measurement can easily affect a
childs percentiles on growth curve charts. Infants should be
placed with the top of the head against the fixed headboard of the
measurement device and with the eye-ear plane perpendicular to
the base of the device (Figure 1). The childs knees must be flat
against the table and the footboard moved until the soles of the
feet are against it, with the toes pointing up.
Am J Clin Nutr 2000;72(suppl):521S8S. Printed in USA. 2000 American Society for Clinical Nutrition
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parameters within a population and are often codified into a
series of growth charts. The following discussion emphasizes the
genetic, nutritional, hormonal, and physical activity factors that
might alter the growth process.
Growth assessment
Linear growth and physical maturation are dynamic processes
encompassing molecular, cellular, somatic, and organismal
changes. Traditionally, stature has been primarily used for growth
assessment, but changes in body proportion and composition are
also essential elements of growth, especially of maturation.
Growth standards have been derived for several populations and
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FIGURE 3. Growth pattern of nutritional dwarfing (A and B) compared with constitutional growth delay (C). A: Patient in whom body weight gain
and height progression decreased after 10 y of age. Extrapolated weight after age 14 y revealed a body weight deficit based on the previous growth percentile. However, there was no body weight deficit for height; with nutritional rehabilitation, there was recovery in weight gain and catch-up growth. B:
Patient with body weight deficit for height but a more marked deficit for theoretical weight. C: Patient without nutritional dwarfing. This patient, with
constitutional growth delay, showed a body weight gain consistently along the lower percentile, with no deviation in growth. Note that there was no body
weight deficit for height or for theoretical weight based on previous growth. Reprinted from reference 26, page 105, by courtesy of Marcel Dekker, Inc.
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SUMMARY
A few compelling data implicate training or competition as
causal in the shorter stature and decreased body mass of some
pubertal athletes in specific sports. It appears likely that activities
such as gymnastics and dance in girls or wrestling in boys select
for those participants with desirable genetic anthropometric traits.
Added to this process are the interactions among diminished nutrition and the energy drain of training. Preliminary hormonal studies cannot distinguish between constitutionally delayed puberty
and a syndrome caused by sport participation. However, studies
designed to make this distinction probably cannot be done in adolescents. Investigations in adult women show that some amenorrheic athletes have altered pulsatile gonadotropin release, but it
has not yet been possible to separate the effect of the training itself
from nutritional and stress factors (48).
REFERENCES
1. Tanner JM. Auxology. In: Kappy MS, Blizzard RM, Migeon CJ,
eds. The diagnosis and treatment of endocrine disorders in childhood and adolescence. 4th ed. Springfield, IL: Charles C Thomas,
1995:13792.
2. Rogol AD, Lawton EL. Body measurements. In: Lohr JA, ed. Pediatric outpatient procedures. Philadelphia: JB Lippincott, 1990:19.
3. Baumgartner RN, Roche AF, Himes JH. Incremental growth tables:
supplementary to previously published charts. Am J Clin Nutr 1986;
43:71122.
4. Tanner JM. Fetus into man: physical growth from conception to
maturity. Cambridge, MA: Harvard University Press, 1989.
5. Sinclair D. Human growth after birth. London: Oxford University
Press, 1978.
6. Smith DW. Growth and its disorders. Philadelphia: WB Saunders,
1977.
7. Tanner JM, Healy MJR, Lockhart RD, et al. Aberdeen Growth Study,
I: the prediction of adult body measurement from measurements
taken each year from birth to five years. Arch Dis Child 1956;31:372.
8. Marshall WA, Tanner JM. Variations in patterns of pubertal changes
in girls. Arch Dis Child 1969;44:291303.
9. Marshall WA, Tanner JM. Variations in patterns of pubertal changes
in boys. Arch Dis Child 1970;45:1323.
10. Berkey CS, Wang X, Dockery DW, Ferris B. Adolescent height
growth of US children. Ann Hum Biol 1994;21:43542.
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