A Longitudinal Study of the Growth and Development of Prematurely and Maturely Born Children: Part VI: Physical Development in Age Period 2 to 4 Years

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Abstract
A statistical analysis is presented of a study of physical growth in the age period 2 to 4 years, in a group of 500 children of varying birth weight. The following conclusions were reached: At 4 years mean weights for the total premature group and mature group are closely related to birth weight for singleton births. In the premature group the highest weight increments are recorded for those who were smallest at birth, and the lowest for those who were between 4 1/2 and 5 1/2 lb. For twin births significantly smaller weight increments are recorded for those less than 5 1/2 lb. at birth, compared with those over this weight. In all birth weight groups lower increments are recorded for twins than for singletons. Larger weight increments are recorded for both singleton and twin boys, as compared with girls. This is largely accounted for by excess male weight increments in the first six months of life. At 4 years the prematurely born are still between 1 and 1 1/2 in. shorter than the mature controls, although increments for all birth weight groups of singletons and twins are inversely related to birth weight. Height increments are approximately equal for boys and girls. At 4 years the prematurely born tend to be lighter and shorter than the controls, and also underweight for their height. The following different factors have been shown to have an effect on rate of growth: (a) Maternal care. [long dash]Lower weight and height increments are recorded in all birth weight groups as standards of maternal care deteriorate. The effect of poor care is most marked on those who were smallest at birth and on twins of all birth weights, (b) Morbidity.[long dash] Smaller increments are recorded with increasing frequency of illness for singletons who were less than 4 1/2. at birth and for twins. Recorded incidence of illness is considered to be a less sensitive index of total environment during the 2 to 4 year age period than it was during the first two years of life. Those prematures receiving the best care and having little illness show larger growth increments, but are still behind the mature controls at 4 years. (c) Gestation period.[long dash] Those children of birth weight 4 1/2-5 1/2 lb. who were born at or near term were both shorter and lighter at 4 years than children of like birth weight who were premature by gestation as well as by weight. The average height of mother was 1 in. less for children between 4 1/2 and 5 1/2 lb. than for children below and above this birth weight, smaller mothers being more likely to have small babies at term. (d) Parental height.[long dash] Rates of growth are significantly correlated with parental heights, as well as with maternal care. Environmental and genetic factors are considered to be of about equal importance in their effect on rate of growth, (e) Feeding problems. [long dash] Prolonged feeding problems during the age period 2 to 4 years appeared to have a definite effect on weight and a lesser effect on height.