Growth Deficiency

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GROWTH IN CHARGE: FOR THE PHYSICIAN

Kim Blake, M.D.
IWK Grace Health Centre, 5850 University Ave., Halifax, Nova Scotia B3J 3G9, Canada kblake@is.dal.ca (902)420-6499

Growth in children with CHARGE has special considerations in each of the three phases: Infant Phase, Childhood Phase, Pubertal Growth Spurt.

1. Infant Phase:
At birth, children with CHARGE Association usually have normal weights and lengths.1,2 However, within the first 9 months of life there is a decline away from the normal growth curve, down to and often below the 3rd percentile. This pattern of growth may be related to repeat hospitalizations, poor feeding, major acute illnesses such as pneumonias and multiple surgeries. The infant phase of growth is mainly determined by nutrition and those children with CHARGE who maintain their weight in the early months are often the ones who have had major nutritional intervention, usually in the form of entral feeding.1

2. Childhood Phase:
Although the growth rate is slower, the childhood phase of growth is the main determinant of final height as it lasts longer than the other phases. Adequate nutrition is important in this phase but also hormones play a role (thyroxine and growth hormone). Growth hormone deficiency is rare but there is an increased incidence in CHARGE.3,4 Pre- adolescent children may have a more normal rate of growth although poor growth in infancy and lack of catch-up growth during childhood often result in a mean height at or below the 3rd percentile.

3. Pubertal Growth Spurt:
Growth deceleration associated with a delay in puberty occurs in more than 70 percent of children with CHARGE and this needs to be monitored closely. Growth in puberty involves the interaction of the sex steroids, especially testosterone and estrogen associated with growth hormone. There is anecdotal evidence that adolescents with CHARGE have fusion of their epiphyses at a later age and therefore often continue to grow in their early 20’s.

The majority of children with CHARGE association have normal results on growth hormone stimulation testing. Arbitrary treatment with growth hormone in patients who have normal growth hormone levels has not been adequately studied and is probably not advised.
Nutrition “Growth and Nutrition are Closely Related”

Children need an adequate quantity and balance of food for optimal growth and development. CHARGE infants who have excessive surgery and a decrease in nutrition intake may require catch-up growth and their energy requirements may be 150 to 200 kcal/kg/d.