I. Engström

Physical growth from birth to 16 years and longitudinal outcome of the study during the same age period

Physical growth of 212 randomly selected Swedish urban children has been investigated from birth to sixteen years as part of a prospective longitudinal study of growth and development. Twenty body measurements have been taken at specified ages. In all, about 66,000 values of measurement have been recorded. At sixteen years 179 (84.4%) ofthe original children were still regularly being followed. Thirty-three (15.6%) of the 212 children left the study at various ages. A comparison between the children who left the study and those remaining did not show any significant differences in physical growth. All recorded data have been scrutinized in order to detect errors of measurement or administrative errors. Such values have been corrected or excluded. The editorial procedures also included the adjustment of each measurement to exact target age, interpolation of missing examinations and exclusion of children with an aberrant growth pattern. When comparing the present study with older Swedish investigations a secular trend was established, while there was good agreement with other contemporary Swedish investigations. Growth charts of distance values of various body measurements are presented. In the charts standard deviation lines (+/- 1, 2, 3 SD) and mean values are plotted. A logarithmic time scale (logarithmic conceptional age) has been used for both practical and theoretical reasons. When evaluating individual values in comparison with reference values standard deviations should be used rather than centiles. With this approach even grossly deviating values can be evaluated. Longitudinal follow-up of individual children and comparison of children of different ages will also be facilitated by this approach.

Analysis of linear growth using a mathematical model. I. From birth to three years.

ABSTRACT. According to the “ICP‐growth model” (ICP=Infancy, Childhood and Puberty components), linear growth during the first three years of life can be represented mathematically by a combination of a sharply decelerating Infancy component and a slowly decelerating Childhood component. Growth as measured by supine length is analysed for 191 longitudinally followed healthy infants using this model. The main aim is to devise ICP‐based methods for biological and clinical applications. The onset of the Childhood component, which occurs some time between 6 and 12 months of age and is typically abrupt, can be detected on an individual basis. Its starting point probably defines the as yet unknown age at which growth hormone begins to exert a significant influence. The analyses have also revealed some new facets of linear growth. Most infants are found to have a non‐linear decelerating Infancy component, free from seasonal influence. Age at onset of the Childhood component is earlier for girls than for boys and is positively related to the magnitude of the Infancy component. During the second year of life the variation in growth rate of the cohort increases. This fluctuation is found to be seasonal and greater for those with late onset of the Childhood component. During the third year of life the growth pattern is stabilized.

Allergic Diseases in Swedish School Children

ABSTRACT. The occurrence of allergic diseases in children was studied on the basis of a questionnaire sent to the parents of 20000 school children, 7, 10 and 14 years of age, in 3 parts of Sweden with different climatic conditions. The prevalence of asthma was 2.4%, allergic rhinocon‐junctivitis 7.4%, eczema 7.8% and total allergic diseases 16.9%. The prevalence of all diseases was significantly higher in the northern part of the country than in the southern parts. This geographic variation was not related to heredity, infant feeding pattern or known exposure variables other than the cold and dry climate. Parental history of allergic diseases increased the incidence in the offspring 2–9 times, with a pattern of symptom specificity and a cumulative effect of double parental history. Breast‐feeding postponed the onset of allergic disease only in children with double parental history.

Somatic Pubertal Development

: The pubertal development of 212 randomly selected Swedish urban children has been investigated as part of a prospective longitudinal study of growth and development. The timing and pattern of pubertal changes were in agreement with the findings in other contemporary studies. The good agreement with data on pubertal development reported in other investigations of Swedish children indicates that the present sample was representative of contemporary Swedish children. Two procedures of assessment of secondary sex characters - clinical examination and whole-body photography - have been compared and contrasted. A clinical examination is less laborious and resource-consuming and also has psychological advantages but should be supplemented in boys by the estimation of testicular volume (orchidometry). In girls the two methods have similar precision and reliability. The first pubertal changes may be observed before 9 years in girls (breast development) and before 10 years in boys (genital development). On average the first change takes place about one year earlier in girls than in boys. Peak height velocity (PHV) is an early event during puberty in girls and a relatively late event during puberty in girls and a relatively late one in boys, the sex difference in mean age being about two years. In girls, menarche is a late event, always occurring after PHV. At the age of 13-14 years some boys and girls have not yet begun theri pubertal development, while others have reached the adult stage.

Characteristics and prognosis of hospital‐treated obstructive bronchitis in children aged less than two years

In a prospective study 101 children aged less than 2 years (median age 10 months), were examined the first time they were admitted to a paediatric ward for asthmatic symptoms. Two‐thirds were boys and 58 had parents or siblings with allergic symptoms. During winter‐spring, respiratory syncytial (RS) virus was verified in 50% of children. Other viral agents were adenovirus, parainfluenza 3, coxsackie B 2, ECHO 6 and rotavirus. At the acute stage, 54% of the children displayed changes on pulmonary X‐ray. The total IgE value was + 2 SD score units in 14 children. At reinvestigation after 3–4.5 years, when the children were aged 3.3–6.3 years, 53% were free from asthmatic symptoms; the median age for the last episode was 2 years. A total of 33% had mild asthma, 8% moderate and 6% severe asthma. The factors which correlated significantly with persistent asthma were: (1) The need for daily medication for at least 6 months. (2) A young age in conjunction with the first wheezing episode and on the first admission to a paediatric ward because of asthmatic symptoms. (3) Other past or present atopic symptoms. Heredity, tobacco smoking at home, having a furry pet, RS virus infection, or high total IgE at the time of the first admission did not correlate significantly with the persistence of asthma 3–4.5 years later. The results emphasize the good overall prognosis of wheezing in early childhood, even when the wheezing is severe enough to lead to inpatient treatment.

Long-term treatment with glucocorticoids/ACTH in asthmatic children. III. Effects on growth and adult height.

ABSTRACT. The effect on growth of long‐term treatment with prednisolone and/or ACTH1‐24 (tetracosactrin) depot preparation was studied in 40 children with severe bronchial asthma. Height velocity was subnormal before treatment. During treatment the group of 17 children primarily treated with ACTH showed a moderate increase in mean velocity. Their height was not significantly altered, and neither was the age at peak height velocity nor adult height. In the group of 23 children treated with prednisolone the mean velocity decreased, resulting in a relative decrease in height. Peak height velocity was delayed by about 2 years in the boys but occurred at the expected time in the girls, as did menarche. Mean adult height was lower than expected after adjustment for mid‐parenteral height. In 10 children ACTH was substituted for prednisolone, and their height velocity increased but not enough to affect adult height, which was just as low as in the patients treated with prednisolone only.

Psychological and Respiratory Physiological Effects of a Physical Exercise Programme on Boys with Severe Asthma

ABSTRACT. Ten boys 9–12 years of age with severe perennial asthma participated in a physical exercise programme lasting 8 months. Pulmonary function and psychological tests were performed before training, immediately after, and one year after the end of the exercise programme. Static lung volumes, flow‐volume variables and histamine tolerance were used as indicators of pulmonary function. Ego structure, body image, social development and concentration capacity were used as indicators of personality development. Before the study, the group had high FRC (p < 0.05) and RV (p < 0.001), low FEV1, MEF50 and MEF25 (all p < 0.001) and low histamine tolerance. They showed marked disturbances in their personality development with low scores in psychological variables. During the training period, MEF50 and MEF25 increased slightly (p < 0.01). Marked improvement was observed in all psychological variables (p < 0.001). The positive effects remained during the following year. The marked and lasting improvement in personality development was regarded as an essential factor behind the more modest positive clinical and pulmonary function changes. The results emphasize the importance of including exercise programmes in the treatment of children with asthma.

Transcutaneous Oxygen and Carbon Dioxide Levels and a Clinical Symptom Scale for Monitoring the Acute Asthmatic State in Infants and Young Children

ABSTRACT. Measurement of transcutaneous PO2 and PCO2 in addition to a clinical symptom grading system wds used to monitor the acute asthmatic attack in children under two years of age. tcPO2 was lowered already at signs of mild obstruction and decreased in parallel with clinical deterioration. tcPCOl was almost unchanged at mild to moderate obstructive symptoms. With clinical deterioration lcPco2, rised steadily. An increase of the oxygen concentration to 30‐40% in the inspired air increased tcP02, on the average by 70%, but did not change the tcPCO2: level. Continuous recording of tcPo2 and tcPCo2 as well as the clinical grading system are valuable tools when monitoring severely obstructive infants and young children.

Nebulized Racemic Adrenaline for Wheezy Bronchitis

Despite investigations showing no bronchodilating effects in children below 18-20 months (l), P-receptor stimulators are widely used at paediatric departments in the treatment of wheezy bronchitis. However, recent studies have demonstrated responders to nebulized P2-stimulators also in the young age group ( 2 , 3). Considering the assumed importance of the oedema component in the obstruction in the low age range, a logical approach would be to treat these children with a combined Pand areceptor agonist, e.g. adrenaline, instead of a selective P2-agonist. The a-receptor stimulation should reduce microvascular leakage mainly by causing constriction of precapillary bronchial arterioles, thus reducing capillary and postcapillary hydrostatic pressure, reversing fluid leakage to resorption, and diminishing bronchial mucosal oedema. Focusing on the low age group, in this study we aimed to test the effects of inhaled racemic adrenaline. Racemic adrenaline is a mixture of the dextroand laevorotatory forms of adrenaline. Naturally occurring adrenaline is in the I-form. The d-form blocks the cardiovascular P1-adrenergic receptors, rather than stimulating them. Therefore, racemic adrenaline should have less cardiac effects.

Long-term Treatment with Corticosteroids/ACTH in Asthmatic Children.: IV. Skeletal Maturation

ABSTRACT. Skeletal maturation in severe bronchial asthma was studied in 15 children during and after treatment with depot tetracosactrin and in 6 children during treatment with prednisolone. Attained skeletal maturity before treatment was below the reference mean in the majority of children. Skeletal maturation was enhanced during treatment with depot tetracosactrin, which led to more advanced attained skeletal maturity at withdrawal than at start of treatment. There was a tendency towards larger increases of skeletal maturity than of height. The influence of adrenal androgens, released by ACTH‐stimulation and good control of the disease are probably relevant factors for the acceleration of skeletal maturation. After withdrawal of depot tetracosactrin the rate of skeletal maturation normalized. During prednisolone treatment there was a delay of skeletal maturation leading to a progressive relative decrease of attained skeletal maturity, and closely related to a delay in linear growth. Treatment with depot tetracosactrin may thus induce enhancement of skeletal maturation, but with the treatment regimen found to be efficacious in bronchial asthma, the effect is not very pronounced and does not perceptibly affect the ultimate outcome of growth.