Outline:

Cleft lip and/or palate (CL/P) is a common congenital anomaly in humans. About a thousand children are born in the United Kingdom (UK) each year with some form of CL/P. Some research has indicated that weight and in particular growth including height (length) and head circumference are reduced in children with clefts when compared with controls at birth and during the first stages of their development ?ADDIN ZOTERO_ITEM CSL_CITATION{"citationID":"dKMtKsJU","properties":{"formattedCitation":"{\rtf\super1\uc0\u8211{}5\nosupersub{}}","plainCitation":"1?5"},"citationItems":[{"id":2078,"uris":["http://zotero.org/users/local/1XkiWLfQ/items/AG8DX9N5"],"uri":["http://zotero.org/users/local/1XkiWLfQ/items/AG8DX9N5"],"itemData":{"id":2078,"type":"article-journal","title":"Birthweight and gestational age of newborns with cleft lip with or without cleftpalate and with isolated cleftpalate","container-title":"The Journal of ClinicalPediatric Dentistry","page":"185-190","volume":"27","issue":"2","abstract":"Thebirth weight and gestational age of 1368 newborns with isolated cleft lip withor without cleft palate and 582 with isolated cleft palate were compared tothose of matched healthy controls. The results indicate that fetuses with oralclefts are at elevated risk of having low and very low birth weight, but not ofhaving a premature birth. Speculations on a relationship between these findingsand the presence of oral clefts arepresented.","note":"PMID: 12597694","journalAbbreviation":"JClin PediatrDent","author":[{"family":"Wyszynski","given":"DiegoF"},{"family":"Sarkozi","given":"Andrea"},{"family":"Vargha","given":"Peter"},{"family":"Czeizel","given":"AndrewE"}],"issued":{"year":2003}}},{"id":2008,"uris":["http://zotero.org/users/local/1XkiWLfQ/items/WAUWUA52"],"uri":["http://zotero.org/users/local/1XkiWLfQ/items/WAUWUA52"],"itemData":{"id":2008,"type":"article-journal","title":"Associatedmalformations in cases with oralclefts","container-title":"The Cleft Palate-CraniofacialJournal: Official Publication of the American Cleft Palate-CraniofacialAssociation","page":"41-47","volume":"37","issue":"1","abstract":"OBJECTIVE

Infantswith oral clefts (OCs) often have other associated congenital defects. Thereported incidence and the types of associated malformations vary betweendifferent studies. The purpose of this investigation was to assess theprevalence of associated malformations in a geographically definedpopulation.

METHOD

The prevalences at birth of associated malformationsin infants with OCs were collected between 1979 and 1996 on all infants born inthe area covered by the registry of congenital anomalies of Northeastern Francein 238,942 consecutive births.

RESULTS

Of the 460 cleft infants bornduring this period, 36.7% had associated malformations. Associatedmalformations were more frequent in infants who had cleft palate (46.7%) thanin infants with cleft lip and palate (36.8%) or infants with isolated cleft lip(13.6%). Malformations in the central nervous system and in the skeletal systemwere the most common other anomalies, followed by malformations in theurogenital and cardiovascular systems. Weight, length, and head circumferenceof children with OCs and multiple associated malformations were lower than incontrols, as was the weight of the placenta. Prenatal diagnosis was rarely doneby fetal ultrasonographic examination in isolated clefts. However, even inmultiple associated malformations, prenatal diagnosis by fetal ultrasonographicexamination had a low sensitivity, 31.6%.

CONCLUSION

The overallprevalence of malformations, which was one in more than three infants,emphasizes the need for a thorough investigation of infants with clefts. Aroutine screening for other malformations especially skeletal, central nervoussystem, and cardiac defects may need to be considered in infants with clefts,and genetic counseling seems warranted in most of these complicatedcases.","DOI":"10.1597/1545-1569(2000)037less than 0041:AMICWOgreater than 2.3.CO;2","note":"PMID:10670888","journalAbbreviation":"Cleft Palate Craniofac.J.","author":[{"family":"Stoll","given":"C"},{"family":"Alembik","given":"Y"},{"family":"Dott","given":"B"},{"family":"Roth","given":"MP"}],"issued":{"year":2000,"month":1}}},{"id":2089,"uris":["http://zotero.org/users/local/1XkiWLfQ/items/VXA3P79B"],"uri":["http://zotero.org/users/local/1XkiWLfQ/items/VXA3P79B"],"itemData":{"id":2089,"type":"article-journal","title":"Longitudinalstudy of growth of children with unilateral cleft-lip palate from birth to two yearsof age","container-title":"The Cleft Palate-CraniofacialJournal: Official Publication of the American Cleft Palate-CraniofacialAssociation","page":"603-609","volume":"46","issue":"6","abstract":"OBJECTIVE

Tostudy the growth of children with complete unilateral cleft lip and palate(UCLP) from birth to 2 years of age and to construct specific UCLP growthcurves.

DESIGN

Physical growth was a secondary outcome measure of aNational Institutes of Health-sponsored longitudinal, prospective clinicaltrial involving the University of Florida (United States) and the University ofS?o Paulo (Brazil).

PATIENTS

Six hundred twenty-seven children withUCLP, nonsyndromic, both genders.

METHODS

Length, weight, and headcircumference were prospectively measured for a group of children enrolled in aclinical trial. Median growth curves for the three parameters (length, weight,head circumference) were performed and compared with the median for theNational Center for Health Statistics (NCHS) curves. The median values forlength, weight, and head circumference at birth and 6, 12, 18, and 24 months ofage were plotted against NCHS median values and statistically compared at birthand 24 months.

SETTING

Hospital de Reabilita??o de AnomaliasCraniofaciais, Universidade de S?o Paulo, Bauru, Brazil(HRAC-USP).

RESULTS

At birth, children of both genders with UCLPpresented with smaller body dimensions in relation to NCHS median values, butthe results suggest a catch-up growth for length, weight, and headcircumference for girls and for weight (to some degree) and head circumferencefor boys.

CONCLUSIONS

Weight was the most compromised parameter forboth genders, followed by length and then head circumference. There was no evidenceof short stature. This study established growth curves for children withUCLP.","DOI":"10.1597/08-105.1","note":"PMID:19860503","journalAbbreviation":"Cleft Palate Craniofac.J.","author":[{"family":"Marques","given":"IlzaL"},{"family":"Nackashi","given":"JohnA"},{"family":"Borgo","given":"HiltonC"},{"family":"Martinelli","given":"AngelaP M C"},{"family":"Pegoraro-Krook","given":"MariaI"},{"family":"Williams","given":"WilliamN"},{"family":"Dutka","given":"JenifferC R"},{"family":"Seagle","given":"MichaelB"},{"family":"Souza","given":"TelmaV"},{"family":"Garla","given":"LuisA"},{"family":"Neto","given":"Jos? S M"},{"family":"Silva","given":"MarcosLN"},{"family":"Graciano","given":"MariaIG"},{"family":"Moorhead","given":"Jacquelyn"},{"family":"Piazentin-Penna","given":"S?lviaHA"},{"family":"Feniman","given":"MarizaR"},{"family":"Zimmermann","given":"MariaC"},{"family":"Bento-Gon?alves","given":"CristinaGA"},{"family":"Pimentel","given":"MariaCM"},{"family":"Boggs","given":"Steve"},{"family":"Jorge","given":"Jos?C"},{"family":"Antonelli","given":"PatrickJ"},{"family":"Shuster","given":"Jonathan"}],"issued":{"year":2009,"month":11}}},{"id":2097,"uris":["http://zotero.org/users/local/1XkiWLfQ/items/NDG4EQTB"],"uri":["http://zotero.org/users/local/1XkiWLfQ/items/NDG4EQTB"],"itemData":{"id":2097,"type":"article-journal","title":"Lineargrowth characteristics of children with cleft lip andpalate","container-title":"The Journal ofPediatrics","page":"707-711","volume":"131","issue":"5","abstract":"OBJECTIVE

Tostudy the linear growth characteristics of children with isolated cleft lip(CL), cleft palate (CP), or both (CLP) and to determine whether this populationis at risk for short stature.

STUDY DESIGN

Retrospective chart reviewidentified 324 patients with CL, CP, or CLP that displayed no additionalcongenital anomalies. Longitudinal height and growth rate analyses wereperformed on routine anthropometric measurements gathered from hospital andclinic records. One-sample t tests (p less than 0.05) of average height percentileswere performed at yearly intervals. Analysis of variance was performed onclefting subgroups.

RESULTS

From birth to 10 years of age, the averageheight of both male and female white patients is consistently near the 40thpercentile. At yearly intervals, 60% of male and 70% of female average heightsdemonstrate statistical difference from the population mean. For all patients,64% of male but only 36% of female growth rates, from 2.5 to 12 years of age, wereabove the population mean.

CONCLUSIONS

White children from birth to 10years of age with isolated CL, CP, or CLP demonstrated a mean height below thepopulation mean. These data suggest that children with isolated cleftingmanifest an intrinsic tendency toward short stature. In addition, male patientsdisplay above-average growth rates, whereas female patients displaybelow-average growth rates, from 2 to 18 years of age. The data imply thatfemale patients may be at increased risk of overall short stature, whereas malepatients may eventually obtain mean populationheight.","note":"PMID:9403650","journalAbbreviation":"J.Pediatr.","author":[{"family":"Cunningham","given":"ML"},{"family":"Jerome","given":"JT"}],"issued":{"year":1997,"month":11}}},{"id":2104,"uris":["http://zotero.org/users/local/1XkiWLfQ/items/JKPPZFQ3"],"uri":["http://zotero.org/users/local/1XkiWLfQ/items/JKPPZFQ3"],"itemData":{"id":2104,"type":"article-journal","title":"Failureto thrive in babies with cleft lip and palate","container-title":"BritishJournal of PlasticSurgery","page":"471-475","volume":"54","issue":"6","abstract":"Weestablished the frequency of failure to thrive (FTT) in children undergoingprimary cleft procedures by using growth charts and standard-deviation scores.Initially, 147 babies with cleft lip and/or palate undergoing 186 primarylip-and-palate repairs were studied between 1993 and 1996. Rates of FTT werecategorised according to cleft type. There was an increasing rate of FTT from32% for unilateral cleft lip and palate to 38% for bilateral cleft lip andpalate to 49% for cleft palate. There was a high incidence of FTT in palatalclefts, especially if these were associated with a syndrome or anomaly (P=0.001). The incidence of FTT with the Pierre Robin sequence was 100%. In viewof the high rates of FTT, two changes were instituted: a feeding-support nursewas appointed to supervise and monitor patients at risk and all patients withthe Pierre Robin sequence had supervised airway management. Thereafter, theincidence of FTT was prospectively studied in 68 babies undergoing 84 primaryprocedures between 1997 and 1999. There was a decrease in the incidence of FTTin comparison with the earlier cohort (9% for unilateral cleft lip and palate,20% for bilateral cleft lip and palate, 26% for cleft palate). There was asignificant decrease in the incidence of FTT in the group with the Pierre Robinsequence, from 100% to 40%. As a result of the provision of a feeding-supportnurse and airway management of patients with the Pierre Robin sequence, theincidence of FTT was reduced and the audit loopclosed.","DOI":"10.1054/bjps.2001.3618","note":"PMID:11513506","journalAbbreviation":"Br J Plast Surg","author":[{"family":"Pandya","given":"AN"},{"family":"Boorman","given":"JG"}],"issued":{"year":2001,"month":9}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"}1-5. The evidence though is not entirely clear ?ADDIN ZOTERO_ITEM CSL_CITATION{"citationID":"GTTgUF2u","properties":{"formattedCitation":"{\rtf\super 6, 7\nosupersub{}}","plainCitation":"6,7"},"citationItems":[{"id":2071,"uris":["http://zotero.org/users/local/1XkiWLfQ/items/5852FGUE"],"uri":["http://zotero.org/users/local/1XkiWLfQ/items/5852FGUE"],"itemData":{"id":2071,"type":"article-journal","title":"Evaluationof growth in patients with isolated cleft lip and/or cleftpalate","container-title":"Pediatrics","page":"e543-549","volume":"125","issue":"3","abstract":"OBJECTIVE

Thepurpose of the study was to evaluate the growth of patients with isolated cleftlip (CL), with or without cleft palate (CP), or CP during the first few yearsof life.

METHODS

A retrospective analysis of data from birth to 5 yearsfor 307 patients with isolated CL/CP or CP alone who were seen in a largecraniofacial center between 1980 and 2007 was performed. We analyzed growthpatterns and feeding interventions. Anthropometric values were plotted onto2000 Centers for Disease Control and Prevention charts. Longitudinal analyseswere performed to estimate age-related changes and to test whether feedinginterventions or early education influenced age-relatedchanges.

RESULTS

Including progressive weight, length, and headcircumference values, a total of 1944 data points were available. The mostfrequent diagnosis was unilateral CL with CP (165 [53.7%] of 307 cases). Nopatients experienced significant failure to thrive during the study period,although predicted weight and length percentiles for age had initial decreasesduring the first year of life, with nadirs at 5.2 and 15 months, respectively.These decreases were followed by recovery that started at approximately 12months for weight and at 20 months for length (P less than .0001). Patients who hadfeeding interventions had a significantly (P = .047) increased gain rate overtime for weight for length, compared with those who didnot.

CONCLUSIONS

In this population, there were weight and lengthdecreases during the first year of life, which were not clinically significantand were followed by statistically significant recovery. Recovery seemed to berelated to successful education and feeding interventions. Head circumferenceand weight for length started at lower percentiles but showed consistent gainovertime.","DOI":"10.1542/peds.2009-1656","note":"PMID:20142284","journalAbbreviation":"Pediatrics","author":[{"family":"Zarate","given":"YuriA"},{"family":"Martin","given":"LisaJ"},{"family":"Hopkin","given":"RobertJ"},{"family":"Bender","given":"PatriciaL"},{"family":"Zhang","given":"Xue"},{"family":"Saal","given":"HowardM"}],"issued":{"year":2010,"month":3}}},{"id":2131,"uris":["http://zotero.org/users/local/1XkiWLfQ/items/9ET5JDVA"],"uri":["http://zotero.org/users/local/1XkiWLfQ/items/9ET5JDVA"],"itemData":{"id":2131,"type":"article-journal","title":"Hospitalization,breast-milk feeding, and growth in infants with cleft palate and cleft lip andpalate born in Denmark","container-title":"The CleftPalate-Craniofacial Journal: Official Publication of the American CleftPalate-CraniofacialAssociation","page":"628-632","volume":"45","issue":"6","abstract":"OBJECTIVE

Toevaluate if the duration of postpartum hospitalization, duration of breast-milkfeeding, and growth during the first year of life in infants with cleft lip andpalate (CLP) and cleft palate (CP) are comparable to infants without facialclefts.

DESIGN

Prospective data collection using a registration chartdeveloped by the authors.

SETTING

Special health care of infants withCLP/CP born in Denmark.

PARTICIPANTS

All mature infants with CLP/CPborn in 2003 and 2004 were included. Of 165 infants, 115 participated in thestudy.

INTERVENTION

In Denmark, parents of children with CLP/CP receivecounseling. This counseling is managed by specially trained healthvisitors/nurses and is initiated at birth. The counseling seeks to supportparents' confidence in having an infant with CLP/CP and to initiate arelationship between the infant and the parents.

MAIN OUTCOMEMEASURES

Duration of postpartum hospitalization, duration of breast-milkfeeding, and weight and length at birth, 5 months of age, and 12 months ofage.

RESULTS

Hospitalization was 4 days and comparable to that ofinfants without CLP/CP. The infants with CLP/CP received breast milk but for ashorter period compared with infants without CLP/CP. Weights at birth, 5 monthsof age, and 12 months of age were identical with Danish growthreferences.

CONCLUSION

The authors find the results satisfactory andbelieve that the counseling provided by the health visitors/nurses plays a partin theresults.","DOI":"10.1597/07-007.1","note":"PMID:18956929","journalAbbreviation":"Cleft Palate Craniofac.J.","author":[{"family":"Smedegaard","given":"Lisa"},{"family":"Marxen","given":"Dorthe"},{"family":"Moes","given":"Jette"},{"family":"Glassou","given":"EvaN"},{"family":"Scientsan","given":"Cand"}],"issued":{"year":2008,"month":11}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"}6, 7. Some studies however suggested that the initial "lag period", especially around birth, is then followed by a later "catch-up" period ?ADDIN ZOTERO_ITEM CSL_CITATION{"citationID":"2e763iojj2","properties":{"formattedCitation":"{\rtf\super 3, 6\nosupersub{}}","plainCitation":"3,6"},"citationItems":[{"id":2089,"uris":["http://zotero.org/users/local/1XkiWLfQ/items/VXA3P79B"],"uri":["http://zotero.org/users/local/1XkiWLfQ/items/VXA3P79B"],"itemData":{"id":2089,"type":"article-journal","title":"Longitudinalstudy of growth of children with unilateral cleft-lip palate from birth to twoyears of age","container-title":"The CleftPalate-Craniofacial Journal: Official Publication of the American CleftPalate-CraniofacialAssociation","page":"603-609","volume":"46","issue":"6","abstract":"OBJECTIVE

Tostudy the growth of children with complete unilateral cleft lip and palate(UCLP) from birth to 2 years of age and to construct specific UCLP growthcurves.

DESIGN

Physical growth was a secondary outcome measure of aNational Institutes of Health-sponsored longitudinal, prospective clinicaltrial involving the University of Florida (United States) and the University ofS?o Paulo (Brazil).

PATIENTS

Six hundred twenty-seven children withUCLP, nonsyndromic, both genders.

METHODS

Length, weight, and headcircumference were prospectively measured for a group of children enrolled in aclinical trial. Median growth curves for the three parameters (length, weight,head circumference) were performed and compared with the median for theNational Center for Health Statistics (NCHS) curves. The median values forlength, weight, and head circumference at birth and 6, 12, 18, and 24 months ofage were plotted against NCHS median values and statistically compared at birthand 24 months.

SETTING

Hospital de Reabilita??o de AnomaliasCraniofaciais, Universidade de S?o Paulo, Bauru, Brazil(HRAC-USP).

RESULTS

At birth, children of both genders with UCLPpresented with smaller body dimensions in relation to NCHS median values, butthe results suggest a catch-up growth for length, weight, and headcircumference for girls and for weight (to some degree) and head circumferencefor boys.

CONCLUSIONS

Weight was the most compromised parameter forboth genders, followed by length and then head circumference. There was noevidence of short stature. This study established growth curves for childrenwith UCLP.","DOI":"10.1597/08-105.1","note":"PMID:19860503","journalAbbreviation":"Cleft Palate Craniofac.J.","author":[{"family":"Marques","given":"IlzaL"},{"family":"Nackashi","given":"JohnA"},{"family":"Borgo","given":"HiltonC"},{"family":"Martinelli","given":"AngelaP M C"},{"family":"Pegoraro-Krook","given":"MariaI"},{"family":"Williams","given":"WilliamN"},{"family":"Dutka","given":"JenifferC R"},{"family":"Seagle","given":"MichaelB"},{"family":"Souza","given":"TelmaV"},{"family":"Garla","given":"LuisA"},{"family":"Neto","given":"Jos? SM"},{"family":"Silva","given":"Marcos LN"},{"family":"Graciano","given":"MariaIG"},{"family":"Moorhead","given":"Jacquelyn"},{"family":"Piazentin-Penna","given":"S?lviaHA"},{"family":"Feniman","given":"MarizaR"},{"family":"Zimmermann","given":"MariaC"},{"family":"Bento-Gon?alves","given":"CristinaGA"},{"family":"Pimentel","given":"MariaCM"},{"family":"Boggs","given":"Steve"},{"family":"Jorge","given":"Jos?C"},{"family":"Antonelli","given":"PatrickJ"},{"family":"Shuster","given":"Jonathan"}],"issued":{"year":2009,"month":11}}},{"id":2071,"uris":["http://zotero.org/users/local/1XkiWLfQ/items/5852FGUE"],"uri":["http://zotero.org/users/local/1XkiWLfQ/items/5852FGUE"],"itemData":{"id":2071,"type":"article-journal","title":"Evaluationof growth in patients with isolated cleft lip and/or cleftpalate","container-title":"Pediatrics","page":"e543-549","volume":"125","issue":"3","abstract":"OBJECTIVE

Thepurpose of the study was to evaluate the growth of patients with isolated cleftlip (CL), with or without cleft palate (CP), or CP during the first few yearsof life.

METHODS

A retrospective analysis of data from birth to 5 yearsfor 307 patients with isolated CL/CP or CP alone who were seen in a largecraniofacial center between 1980 and 2007 was performed. We analyzed growthpatterns and feeding interventions. Anthropometric values were plotted onto2000 Centers for Disease Control and Prevention charts. Longitudinal analyseswere performed to estimate age-related changes and to test whether feeding interventionsor early education influenced age-related changes.

RESULTS

Includingprogressive weight, length, and head circumference values, a total of 1944 datapoints were available. The most frequent diagnosis was unilateral CL with CP(165 [53.7%] of 307 cases). No patients experienced significant failure tothrive during the study period, although predicted weight and lengthpercentiles for age had initial decreases during the first year of life, withnadirs at 5.2 and 15 months, respectively. These decreases were followed byrecovery that started at approximately 12 months for weight and at 20 monthsfor length (P less than .0001). Patients who had feeding interventions had asignificantly (P = .047) increased gain rate over time for weight for length,compared with those who did not.

CONCLUSIONS

In this population, therewere weight and length decreases during the first year of life, which were notclinically significant and were followed by statistically significant recovery.Recovery seemed to be related to successful education and feedinginterventions. Head circumference and weight for length started at lowerpercentiles but showed consistent gain overtime.","DOI":"10.1542/peds.2009-1656","note":"PMID:20142284","journalAbbreviation":"Pediatrics","author":[{"family":"Zarate","given":"YuriA"},{"family":"Martin","given":"LisaJ"},{"family":"Hopkin","given":"RobertJ"},{"family":"Bender","given":"PatriciaL"},{"family":"Zhang","given":"Xue"},{"family":"Saal","given":"HowardM"}],"issued":{"year":2010,"month":3}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"}3, 6 eliminating most of the growth differences compared with the norm at the latest by the age of 5 years ADDIN ZOTERO_ITEM CSL_CITATION{"citationID":"1m1i87p57t","properties":{"formattedCitation":"{\rtf\super6\nosupersub{}}","plainCitation":"6"},"citationItems":[{"id":2071,"uris":["http://zotero.org/users/local/1XkiWLfQ/items/5852FGUE"],"uri":["http://zotero.org/users/local/1XkiWLfQ/items/5852FGUE"],"itemData":{"id":2071,"type":"article-journal","title":"Evaluationof growth in patients with isolated cleft lip and/or cleftpalate","container-title":"Pediatrics","page":"e543-549","volume":"125","issue":"3","abstract":"OBJECTIVE

Thepurpose of the study was to evaluate the growth of patients with isolated cleftlip (CL), with or without cleft palate (CP), or CP during the first few yearsof life.

METHODS

A retrospective analysis of data from birth to 5 yearsfor 307 patients with isolated CL/CP or CP alone who were seen in a largecraniofacial center between 1980 and 2007 was performed. We analyzed growthpatterns and feeding interventions. Anthropometric values were plotted onto2000 Centers for Disease Control and Prevention charts. Longitudinal analyseswere performed to estimate age-related changes and to test whether feedinginterventions or early education influenced age-relatedchanges.

RESULTS

Including progressive weight, length, and headcircumference values, a total of 1944 data points were available. The mostfrequent diagnosis was unilateral CL with CP (165 [53.7%] of 307 cases). Nopatients experienced significant failure to thrive during the study period,although predicted weight and length percentiles for age had initial decreasesduring the first year of life, with nadirs at 5.2 and 15 months, respectively.These decreases were followed by recovery that started at approximately 12months for weight and at 20 months for length (P less than .0001). Patients who hadfeeding interventions had a significantly (P = .047) increased gain rate overtime for weight for length, compared with those who didnot.

CONCLUSIONS

In this population, there were weight and lengthdecreases during the first year of life, which were not clinically significantand were followed by statistically significant recovery. Recovery seemed to berelated to successful education and feeding interventions. Head circumferenceand weight for length started at lower percentiles but showed consistent gainovertime.","DOI":"10.1542/peds.2009-1656","note":"PMID:20142284","journalAbbreviation":"Pediatrics","author":[{"family":"Zarate","given":"YuriA"},{"family":"Martin","given":"LisaJ"},{"family":"Hopkin","given":"RobertJ"},{"family":"Bender","given":"PatriciaL"},{"family":"Zhang","given":"Xue"},{"family":"Saal","given":"HowardM"}],"issued":{"year":2010,"month":3}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"}6.

Aims: We aim to investigate whether there is still evidence for a growth delay within a sample of children with unilateral non-syndromic CL/P (Cleft Care UK) at the age of 5 years when compared with population based controls.

Methods: Using a univariate and or multivariate linear design, we will compare the risk effects of unilateral CL/P (case:control ratio 1:4) on differences in height, weight, BMI and head cirumference measured at the age of 5-7 years compared with age and sex-matched healthy children from the ALSPAC cohort, a sample which is representative of the general UK population.

Confounding issues: We are aware that secular trends in weight, length and head circumference might be associated with differences in birth years(ALSPAC: 1991/1992; Cleft Care UK: 2005/2007). However as our case sample was born ~15 years later than the control sample (ALSPAC), the hypothesis of a growth delay in CLP will, in the presence of a strong secular trend, either support the null hypothesis or show as an effect in the opposite direction (growth increase in CLP), and as such does not invalidate the proposed analyses. Furthermore, there is some evidence that secular trends with respect to adult height are largely stabilised during the last years8 in Northern Europe, and a similar trend might be expected for the UK. All analyses will be adjusted for socio-economic differences.