WIDESPREAD GROWTH-RETARDATION AND VARIABLE GROWTH RECOVERY IN FOSTER-CHILDREN IN THE FIRST YEAR AFTER INITIAL PLACEMENT

Objectives: To determine children's growth patterns in the first year of foster care placement and to compare catch-up growth with initial h eight percentile as indicators of prior growth retardation. Design: In ception cohort. Subjects: Forty-five children aged 1 1/2 to 6.0 years in their first year of foster care. Setting: Urban, community-based pr imary care center. Main Outcome Measures: Height, weight, weight-for-h eight, and annual growth velocity z stores 1 year after placement. Res ults: The group entered foster care with an overall height deficit (he ight z=-0.21), grew at an above-average rate (velocity z=+0.33), and e liminated the height deficit by the end of the year (height z=-0.02; P <.05). Weight increased (baseline weight z=-0.16; year-end weight z=+0 .35) and correlated with height z change (r=0.385, P=.009). Weight for expected weight-for-height-age was above average and did not change ( base-line weight for expected weight-for-height-age z=+0.30; year-end weight for expected weight-for-height-age z=+0.40). Baseline age corre lated with velocity z (r=.413, P=.005) but not with change in height z . Baseline height z did not correlate with either velocity z or change in height z. Three patterns of growth were seen: 21 (47%) showed catc h-up growth (height velocity z=1.34; gain in height z=+0.61); 16 (36%) showed stable growth; and 8 (18%) showed poor growth (height velocity z=-1.49; decrease in height z=-0.49). Conclusions: Almost half of the children showed significant catch-up growth in the first year after f oster care placement, indicating probable prior growth failure. Initia l height was not predictive of future growth, and simple screening (su ch as height less than the fifth percentile) would have missed the maj ority of children who showed catch-up growth. A substantial minority ( 18%) continued to decline across height percentiles after placement. T he initial and subsequent growth failure and catch-up growth in this p opulation did not appear to be related to nutritional changes.