In Reply.—Dr Holmes raises an interesting point with regard to growth in children with the VATER association. Unfortunately, our birth growth data (Table) are not sufficient to determine if the growth-deficient children we reported are SHFD infants with both prenatal and postnatal growth deficiency, or if the growth deficiency develops postnatally. Birth weight for both the normal and deficient growth groups varied from less than the fifth to greater than the 95th percentile. For the length data that we do have, there is an equally wide range. These latter data are inadequate and no conclusion can be drawn with regard to PI. Catch-up growth, if it did occur, normally did not occur in the growth-deficient children until after 3 years of age. This observation would argue against these children being in the low PI category.
We also would like to point out that the VATER association is not a