Growth attainments of well-off chandigarh children: A mixed longitudinal study

Distance and velocity pattern of growth for body weight and height of 134 well-off Chandigarh boys aged 9–17 years, and 109 girls aged 9 to 16 years were studied following a mixedlongitudinal growth study design. For both body weight and height pattern-wise, Chandigarh boys showed close similarity with their American counterparts up to about 13 years of age, while girls did so till 12 years. Where after, Chandigarh children remained lighter and shorter than those of American origin and this differential may be explained on racial grounds rather than nutritional ones since all children included in this study remained free from dietary and other health related constraints. Marginally, higher height growth attainments noticed in Chandigarh children in contrast to their other Indian counterparts during initial years of adolescence shows that Chandigarh children are in process of expressing their genetic growth potential to its full which has not yet been fully achieved. The rate (velocity) of weight and height growth in Chandigarh children remained substatially lower than their sex-matched British counterparts throught the period of study. PHV in boys measured 6.4 cm/yr. and 5.4 cm/yr. in girls. It was attained at the age of 11.5 years in girls and 12.5 years in boys. Peak weight velocity in boys averaged 3.7 kg/yr., while it measured 4.6 kg/yr. in girls. In girls (11.5 yr.), PWV too was attained earlier than boys (13.5 yr.) by two years. The shorter height and lighter weight growth attainments noticed in Chandigarh children in contrast to their Western counterparts may be attributed to slower and lesser magnitude peak growth velocities recorded in Chandigarh children. The use of values presented has been recommended to monitor and assess growth attainments of Indian children residing in the Union Territory of Chandigarh.     

A survey on growth and sexual development of adolescent students in Changhua City: growth of body height and weight

In order to understand the physical growth and sexual development of contemporary adolescents, a cross-sectional survey was conducted during the period September 1983 to May 1984. The population came from all the pupils from 4th grade up, and all the junior and senior high students of Changhua City. By using stratified cluster sampling, 1419 boys and 1599 girls participated, ranging in age from 8 to 19 years. Body weight and height were measured. Growth spurt is a unique event during adolescence. It is well shown in the distance curves and pseudo-velocity curves of body height and weight. In boys, the growth spurt of height spanned from 12.0 to 14.8 years, with peak height velocity (PHV) at 13.5 years. In girls it was from 10.0 to 12.6 years and peaked at 11.5 years. The growth spurt of weight occurred from 12.0 to 15.9 years in boys with peak weight velocity (PWV) at 14.5 years, while girls had a growth spurt at 10.0-12.7 years with PWV at 11.5 years. Girls entered into the growth spurt about 2 years earlier, and also entered into PHV, PWV, two and three years earlier respectively than boys, while boys had a more intense and longer growth during the growth spurt than girls. Between 10.0-13.0 years girls were taller than boys, and between 12.0-13.0 years they were heavier than boys. However, from 13.5 years onward girls were soon surpassed by boys both in height and weight. Growth in height after 16.5 years in boys and after 15.5 in girls was minimal. Growth in weight in boys also became minimal after 16.5 years while girls weight even dropped a little bit after 16.5 years. At the mean age of 17.5 years, boys were 168.1 cm, girls were 156.2 cm in average, boys being 12 cm taller than girls after reaching their final height.     

Growth pattern of the Kamars--a primitive tribe of Chhattisgarh,India

A cross sectional study of the physical growth status was made on 655 Kamar children (341 boys and 314 girls), aged 5 to 18 years, in the Raipur district of Chhattisgarh. The study aimed to find out the growth pattern of the Kamar children, which is considered to be a primitive tribe of Chhattisgarh, India and was compared with another Indian tribe and the official data for all India (ICMR). Anthropometric measurements included height, weight, sitting height, biacromial diameter, biilliocrystal diameter, upper arm circumference, calf circumference and measurements of the triceps and subscapular skinfolds. All anthropometric measurements except skinfold thickness exhibit uniform increase with age in both sexes. However, when height and weight of the Kamar boys and girls were compared with the data for other tribes and for all India, the Kamar children (both boys and girls) indicated lower weight and height and the difference showed to be significant, for almost all ages. Kamar boys showed higher anthropometric values than girls in almost all measurements except in biilliocrystal diameter and in measured skinfolds. Poor socio-economic status of this primitive tribe may be one of the reasons for this poor growth pattern. However, in-depth study is necessary in order to arrive at any basic conclusions and to recommend any policy and interventions.     

A comparison of the point of deflection from linearity of heart rate and the ventilatory threshold in the determination of the anaerobic threshold in Indian boys

The purpose of the study was to assess whether the point of deflection from linearity of heart rate (HRD) could be used as an alternative method to determine the ventilatory threshold (VT) in Indian (Bengali) boys that represents the determination of the anaerobic threshold (AT), and also to standardize an exercise test to be effective in eliciting AT in Indian (Bengali) boys by using HRD. Twenty six (26) boys with a mean age of 12.8 (+/-1.18) years performed a graded maximal exercise test on a treadmill to determine peak VO(2), HRD and VT. The mean peak VO(2), weight related peak VO(2), peak pulmonary ventilation, and peak heart rate of the boys were found to be 1.75 l/min, 47.1 ml/kg/min, 66.9 l/min and 200.2 beats/min respectively. There were no significant differences between mean VO(2), weight related VO(2), pulmonary ventilation (VE), heart rate and respiratory exchange ratio (RER) that were measured at VT and HRD. The mean VO(2) measured at VT and HRD was found to be 1.46 and 1.45 l/min, which were about 84% and 83% of their respective peak values. Linear regression analysis revealed a correlation of 0.94 (p<0.01) between VO(2) measured at VT and VO(2) measured at HRD, so the present study indicates that the point of deflection from linearity of heart rate (HRD) may be an accurate predictor of VT in most but not all boys.     

Household wealth and gender gap widening in height: Evidence from adolescents in Ethiopia,India, Peru,and Vietnam

This study investigates the relationship between household wealth and child height utilizing longitudinal data on 7150 children from Ethiopia, India, Peru, and Vietnam. The concept of conditional wealth is applied to separate the influence of wealth in early childhood. Conditional wealth is the change in wealth that was unpredicted at the age of 5 years. This study finds two dimensions of heterogeneity in the wealth-gradient of adolescent height: gender and stunting status at the age of 5 years. For all four countries in the study, the effect of conditional wealth on adolescent height is stronger for boys than for girls. The estimates for the pooled sample indicate that after the age of 5 years, the growth of children who were stunted at that age is significantly more responsive to conditional wealth than the growth of non-stunted children. The analysis results show that for boys in Ethiopia, a one-standard-deviation increase in preadolescence wealth is associated with an increase of 1 cm (standard error [SE]: 0.3) in height at the age of 15 years. For boys in the Indian state of Andhra Pradesh, Peru, and Vietnam, the corresponding figures are 1.1 cm (SE: 0.4), 1.8 cm (SE: 0.4), and 1.2 cm (SE: 0.4), respectively. The effect of preadolescence wealth on adolescent height is not statistically significant for girls, except in some regions. Overall, the results suggest that household wealth in preadolescence disproportionately benefits the male population in these countries when using height as a proxy for health.     

Progressive deceleration in growth as an early sign of delayed puberty in boys

OBJECTIVE: To describe the prepubertal growth pattern in boys with delayed puberty. METHODS: Growth curves for height and height velocity covering the age range 4-14 years were constructed on the basis of retrospectively obtained data in 85 boys with delayed puberty, who attained a normal final height. RESULTS: Between the age of 4 and 14 years the height in this cohort progressively deviated from the normal reference. At the age of 4 years, the height SDS was already significantly lower (median -0.8; p < 0.001) and progressively diminished during childhood, resulting in a median height SDS of -1.1 at the age of 12 years (p < 0.001). The median final height of this cohort (-0.4) was not different from their target height (-0.2). The degree of deceleration in growth during childhood was not determined by birth weight or birth height and did not influence final height. The decline of the height velocity with age in this group of boys with delayed puberty was significantly smaller (p < 0.001) than predicted by the model of Rikken and Wit. CONCLUSION: Late-maturing boys often show a prepubertal deceleration in growth that starts at an early age but that does not affect final height.     

Growth charts for Croatian school children and secular trends in past twenty years

The aim of this study was to construct new Croatian growth charts for body height and weight of boys and girls aged 6.5 to 18.5 years and to investigate differences between our and pre-existing studies. Analysis was based on a multistage stratified sample representative for school children aged 6.5 to 18.5, 6046 boys and 5656 girls. Growth reference was constructed using LMS method. Present results demonstrated an increment of body height and weight during the last two decades. Highest increase of body height is in boys aged 13-14 years 6.5 cm, in girls aged 12 years is 5.0 cm. Highest increase of body weight is in 16 year age group of boys 8.7 kg and in 11-12 year age group of girls 5.2 kg. In conclusion, regarding presence of secular trend because previously used growth charts in Croatia are obsolete.     

中国汉族儿童生长的长期趋势

本文报告了中国北京、天津、济南、哈尔滨、沈阳、长春、上海、南京、杭州、武汉、广州及成都等12个城市汉族7—18岁儿童生长的长期趋势。 50年代至今,汉族儿童生长的长期趋势是明显的,30年来同年龄儿童身高每10年增长2.66(男)、2.40(女)厘米,体重每10年增长1.64(男)、1.14(女)公斤,近10年来的增长最为显著。生长突增高峰年龄大都提前1—2年。北京、上海、南京、广州、杭州等五所城市自30年代至今,生长长期趋势也是明显的,半个世纪来,每10年增长值,男童身高为1.12—2.66厘米,体重为0.56—1.29公斤,女童身高为1.42—2.67厘米,体重为0.65—1.18公斤。     

Secular changes in height, body weight, body mass index and pubertal development in male children and adolescents in Krakow, Poland

This study examined the secular changes in height, body weight, body mass index and pubertal development in male children and adolescents in Krakow (Poland) over the past 80 years, with an emphasis on the last decade (2000-2010). The survey of the population of Krakow is a continuation of observations conducted in that area for many years. The analysis aims to determine whether in the last decade Krakow still witnessed the secular trend, and what form the trend took. The body height and weight, and body mass index (BMI), of 1862 boys aged 3.5-18.5 years were analysed, against the background of a survey series from the years 1938 (N = 1801), 1971 (N = 2045), 1983 (N = 3124) and 2000 (N = 2328). The mean body height, in almost all age categories, was greater than in the past; however the final height over the last decade remained the same. The mean values of body weight and BMI increased, especially in the last decade. Also, an acceleration of puberty in boys was observed. The last 10 years saw an over 3-month decrease in the age of initial appearance of pubic hair in boys. In conclusion, the last decade saw cessation of the growing taller trend: maximum body height stabilized at approximately 179 cm, but weight and BMI increased. Also, a distinct acceleration of puberty was noticed. Lack of height increase, at the same time as weight gain and puberty acceleration, indicate a progressing developmental disharmony.     

Extreme levels of underweight and stunting among pre-adolescent children of low socioeconomic class from Madhyamgram and Barasat, West Bengal, India

A cross-sectional study on 1206 children (788 boys, 618 girls) aged 1-12 years, belonging to low socioeconomic status, of Barasat and Madhyamgram, West Bengal, India, was undertaken to investigate age and sex variations in height and weight. It also evaluated the levels of underweight and stunting among them. Anthropometric measurements included weight and height. Weight-for-age (WA) and height-for-age (HA) <-2 z-scores were used to evaluate underweight (UW) and stunting (ST), respectively, following the National Center for Health Statistics (NCHS) Guidelines. Results showed that boys aged 4 and 11 years were significantly heavier than girls of corresponding ages. Boys aged 7 years were significantly taller than girls of the same age. Significant (p < 0.001) age differences existed in mean weight and height in boys (weight: F = 336.762; height: F = 565.160) as well as girls (weight: F = 275.320; height = 498.715). Results also revealed that the mean z-scores of WA (WAZ) and HA (HAZ) were less than (negative values) those of NCHS for both sexes at all ages. The overall (age combined) rate of UW was 60.4% and 51.3%; while that of ST was 51.7% and 48.4%, in boys and girls, respectively. Based on World Health Organization classification of severity of malnutrition, the prevalence of UW and ST were very high (> or = 30%) in both sexes. In conclusion, this study demonstrated that the prevalence of UW and ST were very high among the subjects. Since the nutritional status of the subjects is not satisfactory, there is need for immediate supplementary nutrition.     

Weight loss and the effect on stature in children during a residential intervention program

Weight loss is generally high in residential weight-loss programs but the effect of a large weight loss on linear growth is not known. We report the weight loss and the influence on linear growth in a large group of children during a residential weight-loss program focusing on nutrition and physical activity. In a longitudinal noncontrolled intervention study of 990 overweight children (540 girls) attending the weight reduction program from 1990 to 2001 for about 11 weeks (age: 10-14 years, mean BMI-standard deviation score (SDS) at enrollment: 2.83) weight and height were measured initially and after end of treatment. Weekly measurements of height and weight were performed on 138 children. The children lost on average 9.4 kg, reduced their BMI by 4.5 kg/m(2) and BMI-SDS by 0.98. In a multiple regression analysis (P < or = 0.001) weight loss was higher in boys than girls (1.7 kg), higher if the weight was higher at admission (-0.192 kg/kg at baseline) and was positively associated with duration of stay (-80 g/day). Initially the boys' BMI-SDS was higher than the girls' BMI-SDS (P < or = 0.05) but after 8 weeks of treatment the boys had lower BMI-SDS than the girls. There was no negative effect on linear growth during the treatment; on the contrary, linear growth accelerated during the stay as the average increase in height was 2.38 cm corresponding to 11.4 cm/year. In conclusion the children lost close to 1 kg/week during the stay without any negative effect on linear growth. The cause of the linear growth acceleration needs further investigation.     

Growth and nutritional status of the Bharia--a primitive tribe of Madhya Pradesh

This study is an attempt to understand the physical growth and nutritional status of Bharia, a primitive tribe of Central India. A cross sectional study was conducted on 551 children (283 boys and 268 girls) aged 4 to 18 years. Body weight, height, sitting height, head circumference, upper arm circumference, chest circumference, biceps, triceps, sub scapular and calf skin fold thickness were measured. Body Mass Index was calculated as weight/height2 to calculate chronic energy deficiency. All anthropometric measurements except skin fold measurement exhibit uniform increase with age in both the sexes. Age-specific Body Mass Index (BMI) indicated substantial changes and falls during pre-school age and rise in adolescence. The BMI according to the Indian standard was normal, but when the data was compared with the International standard malnutrition in both sexes was noticed in childhood. Boys remained undernourished after adolescence, while girls reached the normal growth patterns.     

Growth and somatotype patterns of manus children,territory of Papua and New Guinea: Application of a modified somatotype method to the study of growth patterns

The growth and somatotype patterns of Manus children, Territory of Papua and New Guinea, reflected in anthropometric measurements and somatotype photographs, is reported for 438 children, ranging from 15 months of age to maturity. Somatotype distributions and individual somatotype photographs indicate little difference between boys and girls from age 1 to 4 years; between age 5 and 9 years boys shift toward higher second component ratings; between age 10 and 18 years boys shift toward higher second and third component ratings, while girls shift toward higher first and third component ratings. Four sample somatotype photographs are representative of the population at age 10 and 14 years, and show age and sex characters easily noted visually. Comparison of height, weight and subscapula skinfold values show that the Manus children resemble the Kaiapit and Bundi children of the New Guinea highlands populations reported by Malcolm in the form of their growth curves but not in growth rates. Manus children grow more slowly than the British, but faster than the Kaiapit and Bundi children. While low skinfold values and height/weight ratios derived from means for height and weight suggest somatotypic similarity of the Manus, Kaiapit and Bundi populations, somatotype photographs are needed for confirmation. Lacking historical information and genetic evidence, we can speculare that diet, nutrition, climate and perhaps physical activity are factors which influence the growth patterns of these populations. The protein intake derived from fish and other seafood may be an important factor in the relatively fast growth and earlier maturation of the Manus. Malcolm thinks that low protein intake plays an important role with the Kaiapit and Bundi, but does not rule out survival value of slow growth and short stature.     

Body height,weight, and skeletal maturation in Hottentot (Khoikhoi) children

Growth of body height and weight and skeletal maturation are discussed, based on 49 male and 61 female Hottentot children aged 3 to 17 years from Warmbad, Namibia (South West Africa) and 124 boys and 113 girls aged 1 to 21 years of related populations, the Rehoboth Basters of Namibia and Cape Coloreds from Cape Town, South Africa. The related populations are taller and heavier than the Hottentots, and have almost the same body height as American blacks and whites at least after the age of 18 years. In the Hottentots and Rehoboth Basters, the mean TW2 skeletal age is always less than the British standard by one or two years in both sexes. In general, the Rehoboth Basters have a skeletal age that is intermediate between Hottentot and British children. In both Hottentots and Rehoboth Basters, the increase in body height shows a linear relation to the skeletal age, and the regression curves are almost parallel in both sexes. The differences in body height and weight between the Hottentots and Rehoboth Basters become greater after the skeletal ages of 15 years for boys and 13 years for girls.     

Sex, age and caste differences in somatotypes of Rajput and scheduled caste adolescents from the Sirmour District of Himachal Pradesh, India

Somatotypes of a cross-sectional sample of 544 rural adolescents ranging in age from 11 to 17 years are described. The sample included 269 Rajput (141 girls and 128 boys) and 275 Scheduled Caste (135 girls and 140 boys) subjects. Each subject was somatotyped using the Heath-Carter anthropometric somatotype protocol (Carter & Heath 1990). In all, ten anthropometric measurements namely height, weight, bicondylar diameters of humerus and femur, flexed mid-upper-arm and calf circumferences, and triceps, subscapular, supraspinale and calf skinfolds were taken. The mean somatotypes of the Rajput boys and girls were 1.62- 3.30-3.85 (mesomorphic-ectomorph) and 2.42-2.90-3.99 (balanced ectomorph), respectively. The mean somatotypes of the Scheduled Caste subjects were 1.51-3.02-3.74 (mesomorphic-ectomorph) for boys and 2.38-2.64-3.70 (balanced ectomorph) for girls. A one-way ANOVA revealed that females of both the caste groups were significantly (p < or = 0.05) more endomorphic than the males. The sex differences in other two components were not significant (p +/- 0.05). Caste differences, as revealed by a one-way ANOVA analysis, were not significant (p +/- 0.05) in both sexes. With the exception of the Rajput girls, the differences in whole somatotypes between those in an early phase of adolescence and those in an advanced phase of adolescence were not significant (p = 0.05). The results indicate that populations exposed to same environmental situations for a long period of time tend to show similarity in physique. A one-way MANOVA analysis, which used Wilk's Lambda as test statistics, revealed that from 11-17 years there was no significant change (p < or = 0.05) in component dominance of mean somatotypes in the boys and girls of the present sample. Among males of a majority of the Indian populations, ectomorphy dominates over endomorphy and mesomorphy from 11 to 17 years.     

Nutritional Status of the Sekmai Children, Manipur

This paper reports on nutritional status of 4 to 10 year-old Sekmai children. The Sekmais belong to a section of the Meiteis of Manipur. They are included in the scheduled caste list of the state. The study is based on height and weight of 731 children, 360 boys 371 girls. It aims to throw light on different conventional methods of nutritional assessments based on height and weight and their varied results. The Sekmai children are shorter in height and lighter in body weight from the American (National Center for Health Statistics) and Indian children in all the age groups. According to Waterlow’s classification of height for age, 43.37% of the Sekmai children are malnourished, whereas Gomez’s classification of weight for age shows 68.67% as malnourished of different grades. But if we look at the classification of Vishveshwara Rao and the Indian Academy of Paediatrics classification (IAPC), the Sekmai children’s nutritional status is not disappointing. Rao’s classification of height for age reveals 88.37% as normal while that of IAPC shows 71.70% as normal. Waterlow’s classification of weight for height also depicts 89.74% of the children as normal. H. Jibonkumar is a lecturer at the Presidency College, Motbung, Manipur, India while T. Shyamacharan Singh is an associate professor of Department of Anthropology, Manipur University, Imphal, Canchipur, India.     

Growth differences between children of highland and coastal Ecuador

This study examines patterns of growth in height and weight among children (<60 months) of highland and coastal agricultural communities of Ecuador. Highland children are significantly shorter, but not significantly lighter than their coastal peers. Linear growth rates (cm/6 months) are comparable between the two samples. Growth rates for body weight (kg/6 m) are similar in highland and coastal boys, whereas highland girls display larger weight gains than their coastal counterparts. In both regions, linear growth is compromised to a much greater extent than growth in body weight, and growth faltering for both height and weight is most pronounced between birth and 24 months of age. The similarity in growth rates between the highland and coastal samples suggests that high altitude hypoxia plays a relatively small role in shaping growth during the first five years after birth. Rather, it appears that most of the disparity in height between the two samples can be attributed to differences established by 6 months of age. The pattern of growth retardation seen in both regions during the first 24 postnatal months is similar to that observed among impoverished populations throughout the world and is likely associated with the influence of nutritional and disease stressors. After 2 years of age, little or no “catch up” growth is seen in height, whereas improvements in weight gain are more pronounced, especially among highland girls. Ongoing research is investigating the nutritional and socio-economic correlates of growth within each region. © Wiley-Liss, Inc.     

Growth reference centiles and secular changes in Turkish children and adolescents

The purpose of the study is to develop current reference growth centiles for Turkish children and adolescents. A cross-sectional growth survey was conducted on 1.427 (709 boys and 718 girls) healthy schoolchildren aged 6-17 years in Ankara, the capital city of Turkey. As an indicator of socio-economic status, the occupation of the parents was recorded. Growth references of height, weight, body mass index (BMI), sitting height, iliospinal height, relative iliospinal height and relative sitting height were constructed by the LMS method. Sex differences, association of parental occupation with height and BMI standard deviation scores were assessed by analyses of variance. Results showed significant sexual dimorphism for height, weight, sitting height and iliospinal height (p<0.001). Significant effect of socio-economic background was found on height and BMI. The prevalence of overweight and obesity was found using the International Obesity Task Force (IOTF) reference criteria 22.4% and 5.6% in boys and 21.2% and 3% in girls. Present results demonstrated an increment during the last three decades in height, leg length and weight curves which is more prominent in boys, but not in the sitting height. This positive secular change appears to be a logical outcome of the gradual changes in nutrition, health care and education, and environmental and economic conditions.     

Growth and nutritional status of Khasi boys in Northeast India relating to exogamous marriages and socioeconomic classes

The Khasis are one of the matrilineal tribes of Meghalaya in Northeast India. They belong to the Indo-Mongoloid racial stock, and speak the Monkhmer language of the Austro-Asiatic group. They have their own traditional religion (Niam Khasi), but about 65% of them have converted to Christianity. A few Khasi members have also embraced Islam through matrimonial relationship with immigrant Muslim males. The present study was based on a cross-sectional sample of 1,351 urban Khasi boys aged 3-18 years belonging to these three religious groups, with a view to understanding the effects of socioeconomic factors on growth and nutritional status, using anthropometric variables such as weight and height. The findings showed that about 60%, 29%, and 6% of these boys were below -2 Z-scores of the US National Center for Health Statistics (NCHS) references in respect of weight for age, height for age, and body mass index for age, respectively. The logistic regression coefficient (beta +/- standard error) indicated that the prevalence of low weight for age (below -2 Z-scores of the NCHS references) was positively associated with age (0.088 +/- 0.014, P<0.0001), while it was inversely associated with household income (-1.216 +/- 0.030, P<0.0001). Likewise, low height for age Z-score was negatively associated with household income (-1.056 +/- 0.130, P<0.0001), although such a relationship was not significant in the case of low body mass index for age (-0.169 +/- 0.229, P>0.05). There were also significant differences between religious groups in respect of anthropometric variables. Allowing for household income, the ANCOVA test indicated that Muslim Khasi boys, who were the offspring of intermarriages between Khasi females and immigrant Muslim males, were significantly heavier and taller than Christian and Niam Khasi boys almost across ages. From about 3-10 years of age, Muslim Khasi boys were, on average, comparable to the 5th and 25th percentiles of the NCHS references of height and weight, respectively. Although it looks as though genetic mechanisms like heterosis and/or gene flow might also be associated with the larger body size in Muslim boys, such a conjecture could only be substantiated or refuted by further studies concerning genetic and more socioeconomic data on both immigrant and nonimmigrant populations.     

Growth curves of children with Down syndrome.

Growth curves of 105 children with Down syndrome (50 boys and 55 girls) were established. At birth height, weight and head circumference of Down syndrome children were lower than these parameters in controls. This delay remained stable until puberty. For weight there was no clear-cut pubertal growth spurt. For stature, the prepubertal growth spurt occurred earlier (at the age of 11 years in boys and 9 1/2 years in girls) than in controls but was less marked. As a result, Down syndrome patients had a short stature with a quite normal weight. These reference curves, available since prenatal diagnosis of Down syndrome is performed routinely, are helpful for monitoring normal and abnormal development in Down syndrome patients.