Growth curves in Down syndrome: implications for clinical practice.

Growth curves have been developed for individuals with Down syndrome (DS) in several countries. However, in order to facilitate the preparation of clinical guidelines it is necessary to verify the eligibility of these curves. The search was conducted according to the PRISMA method (Preferred Reporting Items for Systematic reviews and Meta-Analyses). It was conducted between July 2012 and June 2013 in MEDLINE/PubMed and BIREME. The inclusion and exclusion criteria were applied to identify the studies and a total of 16 relevant articles were selected. The aspects analyzed in the articles consisted of sample size, number of observations, age group, anthropometric variables, standard deviation scores (SDS), type of study, collection and analysis of data, participants, inclusion/exclusion criteria and outcomes. The mean, standard deviations (SDs) and percentiles for sex and age were used to develop the curve of weight, height, and head circumference. The individuals with DS presented growth between -0.4 and -4.0 SDS in comparison to healthy controls. The variation in these observations can be explained by genetic differences, secular trends in growth and disease status. Regarding the limitations identified, it was observed that most of the studies did not provide data concerning the number of individuals and observations, mean values and respective SDs by sex and age. In addition, most studies did not use LMS methods to evaluate asymmetry, the median and data variability. In conclusion, the results of this review demonstrated that in order to avoid false diagnoses in children and adolescents with DS new growth curves must be developed.