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4. Case #1: Use of Growth Charts for Assessing
Pre-pubertal Growth During Adolescence
Discussion
Mandy's case illustrates three key points in the application of growth
charts to pre-pubertal adolescents:
1.
Mandy has not yet reached her adult stature, because she has not yet begun
puberty and has not gone through her growth spurt. Final adult stature
can be affected by many factors, including nutrition and illness, but
her genetic potential with respect to stature can be estimated
from her mid-parental height formula:
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Father's
stature + Mother's stature - 5
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2
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In Mandy's case,
that would be (70 + 64 - 5) / 2 = 64.5 inches for her expected adult stature.
If she were to continue to grow along the 25th percentile, her final adult
stature would be 62.5 inches, 2 inches less than otherwise expected. Although
this may not be important to Mandy at this time, it may become important
to her later.
When pointed out to adolescents, such reduction of growth potential may
be a motivating factor for adolescents to improve their nutrition. The
data from the CDC growth charts are an important element of her health
supervision assessment, but could also be used to motivate changing her
eating behavior to allow an adolescent to reach her/his expected stature.
Improving nutrition would not necessarily result in increased stature.
2. Mandy's fall in weight and stature-for-age
indicate that her growth has slowed more than expected, similar to what
is called "failure to thrive" in younger children. This could
possibly be due to inadequate caloric intake relative to increased energy
needs during puberty. It definitely deserves attention, since it is not
part of healthy growth and development at this age.
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Her interest in ballet and in "not growing up" may
have led to her limiting her food intake through dieting. Also,
it is clear that she is hearing messages from her dance teacher
about not gaining weight too quickly. This may have started as early
as 10 years of age, since her growth curves began to fall off around
that time. From a clinical perspective, that was a time when her
peers may have begun pubertal development and "growing up,"
which could include gaining more than 10 pounds of weight annually.
The CDC growth charts can thus be used to identify the effects of
subtle changes in diet that are not visually apparent in day-to-day
living.
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3. Her family history -- a mother
who is overweight and has diet-related medical complications, and a father
who is a "fitness fanatic" -- are additional risk factors for
Mandy possibly developing dysfunctional eating habits (possibly even an
eating disorder). Bright
Futures: Nutrition, 3rd edition emphasizes a family-oriented approach
to nutrition that is especially important when eating problems arise.
An adolescent's growth and development always need to be assessed in the
context of his or her family and environment.
  
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