According to the Marco’s growth chart data, his weight and stature are within the reasonable range. However, comparing his measurements to the stature-for-age and weight-for age percentiles reveals that Marco is constantly slightly under the 95th percentile constantly, but at the age of six, his weight crossed over the acceptable range (Centers for Disease Control and Prevention [CDC], 2009). He currently has a body mass index (BMI) of 19.15 at the age of 9, which places him slightly under the 95th percentile, so Marco can be considered overweight and may be at risk for developing obesity (CDC, 2012). Although his development is abnormally high, it is not extreme, but precautionary measures should be taken.
James’ growth data shows some signs of potential developmental problems. Upon investigating the data, it is possible to notice that the abnormally low growth rate may be severe. His BMI at the age of eight is only 14.63, but it still places him above the 5th percentile. However, his weight and stature are consistently below the 5th percentile. An investigation of stature-for-age and weight-for age charts with 3rd and 97th percentiles found that his growth is constant at the 3rd percentile, which means further assessments may be required to identify potential growth issues.
David’s growth chart does not indicate any problems. David’s developmental pattern between the ages of two and eight shows that he is consistently around the 75th percentile, which is within the acceptable range. Between the ages of five and six, David showed a slight decrease in weight gain, which placed him at the 50th percentile. However, after the age of six, his weight resumed to develop at the previous rate, so it might be possible to attribute that deviation to situational factors. His BMI is 14.92, which places him within the acceptable range.
In order to record the growth of each child over time, I would have to plot the data on standardized growth charts. That is the correct way of recording the developmental status because it gives the healthcare practitioner a visual indication of previous growth trends and the current state, which enables quick insight into potential problems and identifying deviations that could signal potential risk factors for further development.
It is difficult to identify the exact issue that may be causing abnormal growth patterns because several conditions and genetic factors have been correlated with abnormal developmental patterns. However, it is possible to assume that various genetic factors, growth hormone (GH) production, tissue receptivity, or impaired nutrition can be responsible for abnormal growth patterns (LeBlond, Brown, & DeGowin, 2009).
In James’ case, the slow growth may occur because of genetic and environmental factors. Nutritional growth retardation (NGR) is one possibility, and it is important to refer James to a pediatrician for further assessments. NGR is most likely his condition because his weight is consistently low, so he is at risk of delayed puberty (Lifshitz, 2009). Low GH secretion or lack of tissue receptivity to growth hormones and vitamin D may be the causes of short stature, so a GH stimulation test and a vitamin D deficiency assessment through self-reported dietary intake and lifestyle questionnaires should be administered.
Because Marco shows abnormally high growth and is at risk for obesity, dietary and hormonal factors need to be considered. A GH suppression test should reveal potential problems in GH secretion. If GH overproduction is not treated, it may result in acromegaly once the epiphyses close (LeBlond et al., 2009). A nutrition intake assessment needs to be conducted because Marco is overweight, which may cause insulin resistance, respiratory problems, or joint issues (CDC, 2012).
While David’s chart indicates that his development is normal, it is important to review his medical history or interview his parents to investigate the loss of developmental pace in weight at the ages of five and six. However, the causes are most likely harmless. For example, constitutional growth delay is a harmless condition that slows growth temporarily before it resumes in a normal pace (Lifshitz, 2009). A review of David’s medical history may indicate that some infections or inflammations may have delayed his growth. In any case, David is most likely not affected by growth problems.
In Marco’s case and James’ case, impaired nutrition should be investigated first because it is important to consider that low health literacy may result in wrong infant and child feeding practices, so dietary intake assessments are required (Gibbs & Chapman-Novakofski, 2012). Engaging in patient education is also required to prevent them from making wrong decisions. For example, Marco is overweight, but caloric restriction may damage his adiponectin and leptin secretion which is associated with diabetes development (Pavlovich-Danis & Etienne, 2012).
Second, familial height and weight should be considered to evaluate the role of genetic factors in their development. For example, James might show low stature and weight, but his BMI is within the acceptable range. That might indicate that familial height and weight influenced his development, so the case can be attributed to genetic factors.
However, in both cases, GH tests should be considered to investigate potential hormonal issues and prevent adverse events, especially if nutritional assessment and familial factors do not reveal the causes of their abnormal growth patterns. James requires a GH stimulation test is required because his development is abnormally low while Marco requires a GH suppression test because he shows symptoms of gigantism.
References
Centers for Disease Control and Prevention. (2009). Clinical growth charts. Retrieved from http://www.cdc.gov/growthcharts/clinical_charts.htm
Centers for Disease Control and Prevention. (2012). Childhood overweight and obesity. Retrieved from http://www.cdc.gov/obesity/childhood/
Gibbs, H., & Chapman-Novakofski, K. (2012). Exploring nutrition literacy: Attention to assessment and the skills clients need. Health, 4(3), 120-124.
LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2009). DeGowin's diagnostic examination (9th ed.). New York, NY: McGraw Hill Medical.
Lifshitz, F. (2009). Nutrition and growth. Journal of Clinical Research in Pediatric Endocrinology, 1(4), 157-163.
Pavlovich-Danis, S. J., & Etienne, M. O. (2012). Body fat shapes patients' health. Retrieved from http://ce.nurse.com/RetailCourseView.aspx?CourseNum=ce375-60&page=4&IsA=1
