Sex-Based Prevalence of Growth Faltering in an Urban Pediatric Population

Objective To determine the sex-based prevalence of growth faltering in a pediatric primary, care setting. Study design A total of 33 476 children attending 4 urban pediatric primary care practices affiliated with a tertiary pediatric hospital between July 2002 and June 2005 were studied. Growth faltering was defined as height < 5th percentile or a drop in height s-score by >= 1.5 standard deviations (SD) before age 18 months or by >= 1 SD thereafter. The growth-faltering and nonfaltering groups were compared in terms of sex, race, age, number of clinic visits, and insurance, and by US census tract. socioeconomic status and parental education. Similar comparisons were made for children with height s-scores below -2.25 SD. Results Growth faltering was present in 3007 of the children studied (9%). Univariate and multivariate logistic regression analyses identified significant associations between growth faltering and younger age (P < .0001), Caucasian race (P < .0001), fewer clinic visits (P < .0001), and Medicaid insurance (P < .005), but not with sex nor by residential census tract, median income or proportion with less than high school education. Height below -2.25 SD was associated with male sex (P < .01), Medicaid insurance (P < .01), and more primary care visits (P < .0005). Conclusions The sex disparity in subspecialty growth center referrals (2:1 male:female) is not due to male predominance in growth faltering among children in the urban primary care setting. (J Pediatr 2009;154:567-72)