Child/Adolescent Health

Factors other than gender are associated with poor growth in urban children

Most often, it is boys who visit endocrine specialists for growth evaluations and pediatric growth hormone therapy when they show signs of faltering growth. Some reports show them outnumbering girls by two to one, but this is not because boys are more likely to falter in growth than girls. Instead, growth faltering is related to age, race, insurance, and frequency of visits with the primary care pediatrician, according to a new study.

The University of Pennsylvania researchers studied 33,476 children receiving care from 4 urban pediatric primary care practices affiliated with a large hospital. Among these children, 9 percent experienced growth faltering (height below the 5th percentile or growing abnormally slowly). Growth problems were significantly associated with younger age. Problems peaked in children under the age of 3 years (when failure to thrive is fairly common) and then again in the second decade of life. Boys are especially prone to growth problems in the younger years. Children in the growth-faltering group had an average of 0.5 fewer pediatric primary care encounters during the 3-year study period compared with those without growth problems. This was the most powerful predictor of growth faltering, followed by race. Compared with white children, black children were less likely to have growth faltering, consistent with other studies of growth in U.S. children. Growth problems were also associated with Medicaid coverage. Children covered under Medicaid are often in a lower socioeconomic status and have problems accessing health care. Other studies found that, independent of race or ethnicity, children may experience growth stunting if living below the poverty line.

The researchers note that since boys and children with better access to care are more likely to seek specialist evaluation for growth faltering, it can lead to missed or delayed diagnosis of underlying health problems in girls and low-income children. Their study was supported in part by the Agency for Healthcare Research and Quality (HS13492).

See "Sex-based prevalence of growth faltering in an urban pediatric population," by Adda Grimberg, M.D., Mark Ramos, B.S., Robert Grundmeier, M.D., and others, in the April 2009 The Journal of Pediatrics 154, pp. 567-572.

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