At age 7, Margaretha DeJesus may be thin,
but not to worry: What's more important is that she's shooting up very
fast.
As told to
Lark Lands
This month, Stephen Arpadi, MD, associate
medical director of the Comprehensive HIV Care Center at St. Luke'sRoosevelt
Hospital in New York City, associate professor of clinical pediatrics
and public health at Columbia University and a longtime researcher on
HIV positive children, reviews the growth of his patient Margaretha
DeJesus, 7-year-old daughter of activist and Lab Blab regular Marlene
Diaz.
Marlene has been concerned that Margaretha, at
43 pounds and 48 inches (4 feet) tall, might be too thin. That's a worry
for many parents of HIV positive children who fear that their kids may
be experiencing the "failure to thrive" -- growth failure -- that's
all too common in these youngsters. But in order to know whether there's
a real problem, it must be diagnosed properly.
After the age of two, the most reliable measure
of a child's overall nutritional status is height. But because there
are wide variations in both height and weight in the population, growth
failure can't usually be diagnosed with a single measurement. Except
in extreme cases, if I find your height at a given moment is below average
for your age, all I can say is "You're short." And that might have nothing
to do with growth failure. Maybe your parents are short and that's just
your genetic heritage. What doctors are interested in is the growth
rate, or "growth velocity" -- whether the child is continuing to grow
at an appropriate rate over time. The simplest way to determine that
is to measure height at least twice each year and, using tables to determine
the child's percentile for that age (what percentage of kids are that
height or shorter), track changes over time.
If the initial height measurement shows that
a child is in, say, the 50th percentile, I'd want to see him or her
stay close to that percentile. A low percentile would be fine -- as
long as he or she continues to grow well enough to stay in at least
that percentile. But if the child dropped from a higher to a lower one,
that could mean that he or she may be experiencing growth failure. In
Margaretha's case, two years ago she was in the 15th percentile for
height. Now she's in the 50th, making her rate of growth above average.
She's actually playing catch-up.
Credit for the improvement should go to her good
viral control with ddI (Videx), d4T (Zerit) and nelfinavir (Viracept),
combined with her mother's constant efforts to boost her food intake.
Both factors are very important. In fact, the first step to help kids
grow better is to suppress their virus, which often leads to improved
appetite. So effective HAART is a must. The other key strategy is getting
the most bang for the buck with food. Eliminate empty-calorie items,
especially such stomach fillers as sodas, and load kids up with nutrient-rich
foods. Always exploit whatever food they're eating. No cracker should
go uncovered by peanut butter. Chips shouldn't be eaten without the
bean dip. Make every bite count.
Despite Marlene's concern about her daughter's
low weight, Margaretha has actually gone from the 5th percentile to
the 25th in the past two years. Because of the wide variability in childhood
weight levels, measuring weight may be of limited value in identifying
growth failure (unless the underweight is severe). As with Margaretha,
low weight may just mean that the child is a picky eater who's naturally
thin. It's not a problem as long as he or she is still gaining height
appropriately. That's what Margaretha is now doing, having moved from
the low end up to almost average height. I think she's just where she
needs to be. And, yes, she's skinny, but in the normal range -- and
probably looks just like her mom looked at this age.
Up,
Up and Away
Margaretha's Growth in Inches |
