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Abnormal Growth 45

along with BMI, with girls gaining fat at a slightly     puberty may be an indication of excess growth
higher rate than boys. This increase in BMI is           hormone but a referral needs careful consideration
termed the adiposity rebound. The timing of it is a      as the accuracy of height measurements is often
crucial marker and intervention point for                poor. In addition, early puberty is becoming more
childhood obesity.                                       common.

Crossing centiles during                                    In children over 2 years, a BMI that is over the
adolescence                                              91st centile is considered overweight and a BMI
                                                         over the 98th centile is considered obese. Families
The pubertal growth spurt occurs at different ages       of these children may need to make lifestyle
in children but the growth charts describe an            changes to reduce the rate of weight gain in the
average growth spurt at the average age of the           child (see Chapter 7.2).
pubertal growth spurt. Children who go through
their pubertal growth spurt at a younger or older        Acknowledgements
age than the average age will therefore cross centile
lines on the chart. This needs to be taken into          Thanks are due to Professor Mehul Dattani,
consideration when assessing height and weight           London Centre for Paediatric Endocrinology,
gain around this time. See Chapter 6.2, page 173.        University College London and Professor Tim
                                                         Cole, MRC Centre of Epidemiology for Child
Abnormal Growth                                          Health, University College London.

Poor growth or extremely rapid growth may be the         References and further reading
first indication of an underlying medical condition
that requires further investigation. Faltering           Department of Health (2011) National Child
growth is defined as weight or height falling               Measurement Programme. www.dh.gov.uk/en/
through 2 centile spaces after allowing for                 Publichealth/Obesity/DH_073787 (accessed 28
adjustments up or down on the centile charts in the         July 2011).
first 6–8 weeks (see Figure 2.1.4). Rapid growth is
defined as crossing centiles upwards on the weight       Elliman D and Hall DMB (2006) Health for All
or height centile charts. Rapid weight gain is a risk       Children, revised 4th edn. Oxford: Oxford
factor for obesity.                                         University Press.

   Referral to a paediatrician should be considered      Fayter D, Nixon I, Hartley S, et al. (2008) Effectiveness
if:                                                         and cost-effectiveness of height screening
                                                            programmes during the primary school years: a
●● weight or height is noted, for the first time, to be     systematic review.  Archives of Disease in
   below the 0.4th centile                                  Childhood 93: 278–284.

●● weight or length/height falls through 2 centile       NICE (National Institute for Health and Clinical
   spaces and increasing energy intake from food is         Excellence) (2008) Public Health Guidance 11.
   not successful in restoring normal growth velocity       Improving the nutrition of pregnant and
                                                            breastfeeding mothers and children in
●● BMI centile is below the 2nd centile.                    low-income households. March 2008. London:
                                                            NICE.
Height crossing more than one centile space
upwards in children over 3 years of age and before       Tasker R, McClure R and Acerini C (2008) Oxford
                                                            Handbook of Paediatrics. Oxford: Oxford
                                                            University Press.
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