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Unfortunately, Sometimes it May Be How You Start Out That Makes the Difference

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If the researchers from Finland who evaluated the performance levels of 106 undersize infants and compared them to 105 more or less normal size infants performed their study well, we would be forced to admit, “unfortunately, sometimes it may be how you start out that makes the difference.” Their work, reported in the Archives of Pediatric and Adolescent Medicine’s February 2002 issue titled “Academic achievement of small-for-gestational-age children at age 10 years,” has to be rather discouraging for those parents whose newborn infants had birth weights below the 2.5 percentile on the population-based fetal growth chart. It seems that the only hope these parents have that their small-for-gestational-age (SGA) babies will one day do just as well as appropriate-for-gestational-age (AGA) babies is that somehow Doctor Hollo and his group miscalculated, or utilized improper evaluation techniques, when they concluded that SGA children will not perform as well academically when they reach ten years of age. Otherwise, only luck will decide whether their infants grow up able to compete with their more fortunate contemporaries. So, let’s examine their approach, results, and conclusions to see if there may be some reasons for disagreement with the findings.

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The first thing to point out is that this study only measures academic achievement. Whether smaller infants will also be less competitive in sports, manipulative skills, ability to cope, or any of the numerous other accomplishments required for a successful future is still up for grabs. The second thing to mention is that comparisons were only made with appropriate-for-gestational-age children, not for example, with overweight children. Another question is; why was the infant underweight in the first place? Was it due to illness of the mother, small size of the parents, parental drug abuse, etc, or was it truly due to some harmful problem encountered during the fetal intrauterine existence?

Suppose we examine how several other factors involved in reaching conclusions for this study might have played a determining role. As far as family background is concerned, all the parents were ethnically homogeneous Finnish, except for one Indian father and one Portuguese mother. Eight of the small infants were preemies, and thirteen were twins. Let’s think about these factors for a moment. True, ethnic homogeneity is important from a statistical viewpoint, but what about the potential differences created, for instance, if a homogeneous society tends to prize height as a virtue? We can only surmise the role that this might play in a Finnish society. Will smaller birth-weight children also be shorter when they get older, then be treated as inferiors, and therefore grow up with inferiority complexes? In other words, what caused the poorer academic achievement, the original size, or the later taint produced by being small while everyone else is tall. How about being premature? What counts as more significant, being small, or starting out life with a struggle? Checking the statistics revealed that eight of the normal size children were also premature so this factor is diminished — yet, not completely. One would think that being both premature and small (perhaps because the birth was much earlier in the pregnancy) tends to be more traumatic. However, is intellectual capacity also at risk? The authors did exclude chromosomal or congenital abnormalities so these factors played no role. Perusal of the statistics revealed no evidence that any of the normal size children were twins unless this was somehow missed. Is being a twin an advantage or a disadvantage? If one twin (perhaps not identical) performs better than the other, will the inferior sibling then retreat into greater obscurity?

Then we have another large discrepancy between the two groups. The smaller children included 67 girls and 39 boys while the normal size children included 51 girls and 54 boys. Only Finnish educators can answer whether this obviously marked preponderance of females would play a significant role in their society by increasing or decreasing the level of potential educational achievement. It seems that an appropriate comparison would require that the sex distribution be comparable.

Numerous other rather intricate statistical details were included in this evaluation, but it would not be possible to examine them all under a retrospective microscope in this review. Suffice it to say, some doubts exist as to the veracity of the conclusion, “Being SGA at birth has a clinically significant impact on the academic achievement of a 10 year old child.” For that matter, what about choosing the age of 10 as the appropriate point in life for making a proper comparison? Adolescence, and its immense hormonal forces may well be capable of reversing cognitive abilities and for that matter, evening up sizes. Just think about how adolescent girls mature so much earlier than do boys. Another factor independent of original size was present as well. Many more of the SGA children came from unfavorable backgrounds, a distinct educational disadvantage.

Is this a flawed study, providing a disheartening conclusion that might lead to inappropriate expectations for those unfortunate children who were born smaller through no fault of their own? I leave it to you, the reader, to judge for yourself. Perhaps better comprehension of the needs of SGA children during their early formative years, without placing a label of poor potential for academic achievement in the way, will serve to alleviate these perceived inadequacies.





When our folks were young they all were small

Only circus giants were big and tall,

And a basketball hoop at ten feet high,

Was as hard to reach as a bird in the sky.

When we were young we grew much bigger,

And each generation gets taller and taller,

Today our kids are higher than we were,

Tomorrow their kids’ll be higher than they are.

At the rate we’re going it’s hard to say,

If they’ll ever shoot down at the hoop to play,

And I wonder one day how it all may end,

Will the wind blow ’em down, or will they simply bend?

low birth weight baby

Cartoons and Poems following each article are created and copyrighted by Dr. Ackerman and cannot be copied or reproduced without his permission.
Copyright © 2006 by Marvin Ackerman, M.D.










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