Growth Charts for Children with Down Syndrome

According to the Centers for Disease Control and Prevention (CDC), "Down syndrome remains the most common chromosomal condition diagnosed in the United States." Infants and children with Down syndrome are at increased risk for health- and nutrition-related issues and may need additional services beyond those required by children without intellectual and developmental disabilities and special health care needs. It is imperative that the registered dietitian nutritionist (RDN) perform a comprehensive nutritional assessment so that individualized nutrition interventions may be developed and include caregivers and other members of the health care team.

A major aspect of the ongoing assessment is to monitor the child's or infant's growth pattern, as major deviations may indicate a cause for concern. Early identification of a growth problem is important because timely interventions may positively affect the child's general health and functional abilities as well as support growth. Malnutrition or underweight is a risk for individuals with Down syndrome during infancy. This risk shifts later in childhood, where short stature and hypotonia may reduce energy needs and raise the risk for increased body weight.

Weight and length or height and head circumference are the recommended anthropometric measurements that are generally recorded onto growth charts to monitor progress of young children. Because children with Down syndrome may grow more slowly and have shorter stature than their peers without Down syndrome, special growth charts have been developed. Although, limitations regarding the use of specialized growth charts for Down syndrome have been noted in terms of their representation of the wider population, the American Academy of Pediatrics (AAP) currently recommends using the Down syndrome-specific growth charts from the CDC and provides guidance based on the child's age (i.e., 1 month to 1 year, 1 to 5 years, 5 to 12 years, 12 years and older). Starting at age 2, weight trends can be monitored using Down syndrome-specific body mass index (BMI) charts; however, at age 10, the AAP indicates that the standard BMI charts from the CDC are a "better indicator of excess adiposity for children with Down syndrome" compared to the Down syndrome-specific BMI charts, as indicated by research conducted by Hatch-Stein et al.

The RDN should monitor growth based on the appropriate chart and use this information in the assessment of the infant or child who has been diagnosed with Down syndrome. It is the expectation that each child will grow at his or her own potential, even if it is below the normal growth curves using the above-mentioned growth charts. It is acceptable for a child to grow at slower rates if they are consistently tracking along a satisfactory curve as determined by the clinician.

References:

• Centers for Disease Control and Prevention. Facts about Down Syndrome. Accessed June 7, 2022.
• Wittenbrook W, Green Corkins K. Pocket Guide to Children with Special Health Care and Nutritional Needs, 2nd ed. Behavioral Health Nutrition Practice Group and Pediatric Nutrition Practice Group. Academy of Nutrition and Dietetics; 2021.
• Academy of Nutrition and Dietetics, Pediatric Nutrition Care Manual. Down syndrome. Accessed May 31, 2022.
• Bull MJ, Trotter T, Santoro SL, et al. Health Supervision for Children and Adolescents with Down Syndrome. Pediatrics. 2022;149(5).
• Hatch-Stein JA, Zemel BS, Prasad D, et al. Body composition and BMI growth charts in children with Down syndrome. Pediatrics. 2016;138(4):e20160541.