Risky vs rapid growth in infancy: Refining pediatric screening for childhood overweight

Objectives: To systematically analyze growth data from infant health maintenance records to characterize infant weight gain increasing risk for childhood overweight, and to identify additional information from those records that could refine risky infant weight gain as a screening tool. Design: Retrospective cohort study. Setting: A pediatric office in central Pennsylvania. Participants: Children aged 6 to 8 years (n = 129) born in 2000 or later who attended health maintenance visits. Main Exposures: Risky infant weight gain was a cutoff selected after considering its sensitivity and specificity during the interval best predicting childhood overweight risk as determined with receiver operating characteristic curve analysis. We identified demographic, growth pattern, and parental feeding choice differences between at-risk infants who did and did not become overweight children. Main Outcome Measure: Childhood overweight, defined as a sex- and age-specific body mass index of the 85th percentile or higher at ages 6 to 8 years according to 2000 Centers for Disease Control and Prevention growth charts. Results: Childhood overweight prevalence was 24.8%. At-risk infants gained at least 8.15 kg from ages 0 to 24 months. While 31.4% of at-risk infants became overweight children, 68.6% were resilient. At-risk, resilient participants had parents with more education, had lower weight gain from ages 18 to 24 months and 0 to 24 months and a smaller area under the weight-gain curve from ages 0 to 24 months, were more often exclusively breastfed for 6 months or longer, and were introduced to solid foods later than at-risk, overweight participants. Conclusions: While most researchers would not recognize weight gain of 8.15 kg or more from ages 0 to 24 months as rapid growth, it was a fair screening tool for childhood overweight in our sample and had the potential to be refined using information about demographic characteristics, growth patterns, and parental feeding choices.