General body growth in children with cleft palate and related disorders: Age differences

Abstract

Clefts of the lip and palate, separately or in combination, are among the most frequent congenital defects seen today. Their etiology is heterogeneous and may include hormonal factors, which suggest the possibility of growth effects. Whether affected children are smaller than others has not been determined. We recently showed that growth status is associated with type of cleft. We hypothesized genetic alterations in metabolic pathways that alter prenatal growth, producing clefts; some of these alterations also alter postnatal growth. Since the levels of growth-regulating hormones change during ontogeny, we expected age differences in the degree of growth deficit seen. To test this hypothesis, we examine here the cross-sectional means and distributions of standard deviation (z) scores for height and body mass indices (BMIs) for 144 children with the diagnoses unilateral cleft lip and palate (uCLP) and isolated cleft palate (iCP). We find that alteration in growth status is associated with age group as well as sex and diagnosis.

Growth in Children with Clefts: Serial Hand-Wrist X-Ray Evidence

“…Differences between cross-sectional studies of growth accomplishment and the longitudinal approach in individual children used here also may contribute to discrepancies among studies, as Tanner (1962) has emphasized. The results presented here confirm the earlier anthropometric results from my colleagues and my earlier work, which showed that growth accomplishment in children with clefts differs by both cleft type and chronological age (Bowers et al, 1987(Bowers et al, , 1988a. This work also replicates Prahl-Andersen's findings of advanced SA in girls with CLP (Prahl-Andersen, 1979).…”

“…Krogman had argued that children with clefts usually reached heights within the normal range (1979). Our earlier work, however, appeared to indicate that they have growth defects (Bowers et al, 1987(Bowers et al, , 1988a. We had found that children with bony clefts have altered bone growth throughout their bodies, as seen in their reduced elbow breadths (Bowers et al, 1988b).…”

“…For boys with CL and UCLP, average z scores were significantly negative for height and BMI for those 2 years 0 months to 7 years 11 months and for the combined group 2 years 0 months to 13 years 11 months. For girls with these anomalies, z scores for heights were significantly negative for the combined group 8 years 0 months to 18 years 11 months (Bowers et al, 1988a). Demonstration of relationships, however, is difficult because the relationships are not simple, and some of the effects are established early in ontogeny.…”

“…Data for boys and girls are analyzed separately because their growth patterns differ. Those with isolated CP have been separated from both those with UCLP and those with BCLP because our earlier work (Bowers et al, 1987(Bowers et al, , 1988aBowers et al, 1988b) suggested that growth patterns among children with various kinds of clefts were also different. Children with isolated cleft lip were dropped from the study when they were found to be too few for informative analysis.…”

“…More recently this has been replicated by Cunningham and Jerome (1997) from the Seattle (WA) Craniofacial Program. In a second paper we showed that growth accomplishment in children 2 years 0 months to 18 years 11 months varies with age level as well as sex and cleft type (Bowers et al, 1988a(Bowers et al, , 1988b. Our age-level divisions were at 7 years 11 months and at 13 years 11 months.…”