Weight growth disorder
The following two points must be taken into account when adopting the above definition: ⑴ According to the normal distribution rule, 3% of normal children weight It should be lower than the third percentile (but most people whose weight is lower than the 300th percentile do have growth disorders). ⑵ If growth disorder occurs, the ideal weight calculated according to height must be corrected according to the expected height (the expected height is determined according to the height growth curve), rather than the actual height About 3%~5% of the patients with growth disorders were sent to health centers and 1% were sent to hospitals for treatment
Etiology and pathophysiology
The physiological basis of growth disorders (FTT) caused by any etiology is related to malnutrition
Organic FTT refers to growth disorders caused by acute and chronic diseases that interfere with the intake, absorption, metabolism or excretion of normal nutrients, or increase energy demand (Table 262-1)
Non organic FTT often refers to growth disorders caused by environmental neglect (such as lack of food) or environmental deprivation. About 80% of FTT children cannot find the cause of growth inhibition. The lack of food may be related to poverty, lack of feeding skills, inappropriate milk formula, etc., such as over dilution of milk powder due to economic difficulties, or fatigue and tension of mothers, Malnutrition and other causes insufficient supply of breast milk
In most cases, the psychological factors of non organic FTT are related to hospitals and health education. Infants who lack environmental stimulation will become depressed, pessimistic and anorexia. The lack of stimulation of non organic FTT children may be caused by the depression and pessimism of caretakers (usually mothers) themselves, the lack of parenting skills, and the fear of failing to complete their care responsibilities. Other factors in the environment, For example, marriage crisis and economic difficulties are also very important
However, the mother's nursing errors are not enough to explain the character of children with non organic FTT. The reaction ability also affects the mother's emotion. Non organic FTT can be considered as the result of the communication barrier between the mother and the child. Therefore, non organic FTT has different forms. Serious types of children have diseases, even for the most capable parents, The infant feeding is also a challenge. The other situation is that a basically normal child is taken care of by a mentally ill parent who lacks sufficient socio-economic foundation. Both extremes are incompatible between mother and child. In this case, the child's needs cannot be fully met from the mother
In mixed FTT, there are both organic and non organic causes of FTT, and doctors must identify the relative role of each cause in FTT. Mixed FTT often occurs in preterm infants, and growth disorders occur in late childhood. Patients may have some physiological defects, but they cannot explain the current growth disorders, such as cleft palate repair, and sucking difficulties caused by neural causes, The customer's aversion should also be investigated
Other symptoms of growth disorders
In addition to the growth disorder symptom that the body weight continues to be lower than that of the corresponding age, there are figure Other growth disorders such as dwarfism, sexual organ and secondary characteristic dysplasia also belong to the scope of growth disorders. There are a few children who have reached the age when they should grow, but their growth has stopped, and no corresponding sexual development changes have taken place. This is called growth delay and growth disorder. The children with delay and growth disorder both have short stature, stunted sexual organs and secondary characteristics, but there are some differences in their essence. Growth delay refers to that the children's growth and development is delayed, but can finally reach the normal level. Growth disorder refers to that the normal growth and development process is blocked, and they cannot grow again without treatment.
Some children belong to genetic Shortness is not a growth disorder. These children are completely healthy and normal. Their short stature is caused by familial genetic factors. No treatment is needed for them. It is also completely ineffective to stimulate growth with growth hormone or androgen, because their hormone levels and those of their parents are completely normal. The most common endocrine There are two reasons, namely growth hormone Lack and thyroid hormone lack. Growth hormone deficiency is mostly idiopathic, and only a few secondary to intracranial lesions, such as craniopharyngiomas. Most of these tumors are benign and can be removed surgically. These children are short in stature. They are seriously dwarf, but their intelligence is generally in the normal range. The use of growth hormone for such children can achieve good results, but the treatment period is very long (from childhood to adolescence, the whole process needs to be treated, 2-3 intramuscular injections per week), until the growth naturally stops. If the child is also accompanied by other pituitary hormone deficiency, symptomatic treatment should be taken at the same time. Lack of thyroid hormone can also stop growth. Because thyroid hormone is an important factor to promote cell differentiation, in addition to short stature and underdeveloped sexual organs, children will also have mental retardation (because of incomplete differentiation of brain cells), stupid face and other manifestations. If insufficient thyroid hormone secretion occurs in the fetal stage of rapid differentiation of brain nerve cells, the condition is more serious. Therefore, in recent years, the routine screening method of determining thyroid hormone in blood has been used for newborns abroad in order to achieve good results in early diagnosis and treatment.
The adverse effects of pituitary gonadotropin deficiency on growth are also common. In girls ovary Dysplasia, Secondary sexual characteristics Lack, but most of the intelligence is relatively normal. These girls still have very little gonadotropin in their urine during puberty, while boys cause secondary development testis Low functionality, these boys' reproduction organs And the second sex sign is delayed and undeveloped, the penis is like a baby, the pubic hair and axillary hair are rare, and there is no beard. Due to insufficient testosterone secretion, the children's muscles were weak and weak, the chest and shoulder were narrow, the epiphyseal healing was significantly delayed, and the long bones continued to grow. As a result, the length of the limbs exceeded that of normal people, showing a characteristic tall and thin man. Because of the different nature of the disease, organic FTT can appear in children of any age. Most children with growth disorders appear within one year old, or even six months ago
Weight is the most sensitive indicator of growth disorder. The decrease of growth curve indicates that the patient has serious long-term malnutrition. When protein/energy is insufficient, brain development is affected by malnutrition the latest. Therefore, the decrease of head circumference growth occurs later and often indicates very serious and long-term malnutrition
Generally, when a growth disorder patient is found, he/she should know the medical history (including diet history - Table 262-2), carefully inquire about the diet, provide diet counseling, and often monitor the weight of the child. If the weight growth of the child is still unsatisfactory, he/she should be hospitalized for necessary observation and examination, It is difficult to identify organic FTT in non organic FTT based on simple clinical characteristics. Before establishing a diagnosis of non organic FTT, doctors should find potential clinical manifestations for FTT patients, pay attention to personality, family characteristics and other psychosocial FTT assessments. It is best to be conducted by multidisciplinary experts, including physicians, nurses, nutritionists, and children development experts, Social workers, psychoanalysts and psychologists. It is essential to investigate the feeding, nursing and parents of children, whether they are outpatients or inpatients
It is necessary to cooperate with parents to investigate the causes of growth disorders, which can get their respect and cooperation. Avoid blaming them in the investigation, because these parents may feel depressed or guilty psychologically because they are unable to feed their children well. Staff should be welcomed by them and support parents to try feeding methods, Provide toys and make suggestions to promote parents and children to play and communicate together. Staff should not comment on FTT for parents' irresponsible or other mistakes
The staff should praise the parents for their correct practices and their sense of responsibility. They should report the neglect or abuse of care to the Social Service Department. In many cases, it is important to take more preventive measures to meet the family's needs for children's education, such as introducing children's care methods and letting parents attend parents' education courses
During hospitalization, carefully observe the relationship between the child and other people, and record self stimulating behaviors, such as shaking and headbutting. Children with non organic FTT are often described as highly alert, careful to contact people, and would rather communicate with inanimate objects if they can. Although children with non organic FTT are more often found in neglected families than scolded families, However, it is still necessary to closely observe the evidence of abuse. The children should also be screened for their development level, and if necessary, more complex examinations should be carried out
The FTT tests recommended by most experts include: CBC, ESR, urine analysis (including concentration and acidification ability), BUN or serum creatinine level, urine culture, stool examination (including pH, reducing substances, color, character and smell). Too many laboratory tests often have no results. According to the prevalence of the disease in the local area, blood lead level determination was selected, Detection of H Ⅳ antibody and intradermal tuberculin test. If the child has obvious nausea and vomiting, the electrolyte concentration can be measured. When the growth of height is more affected than the growth of weight, the thyroid hormone level should be measured. When there are recurrent respiratory disease attacks, accompanied by dyspepsia and hepatomegaly, the relevant examination of cystic fibrosis should be performed. Those with fever, nausea and vomiting, Infection related examinations should be carried out. The radiology department should carry out examinations for diseases with anatomical or functional abnormalities, such as pyloric stenosis, gastrointestinal reflux, etc
Clinical diagnosis How to detect whether children have growth disorders at an early stage? The following methods will help you:
1. Compare with the height of other children of the same age and sex. For example, the average child in the class has become shorter year by year, indicating that the growth of the child is slower than that of other children.
2. Measurement height : According to the age, the measurement shall be carried out every six months to one year. The infants and young children can be measured with a tape measure in a lying position. Children over 3 years of age can nail a tape measure on the wall for measurement. When measuring, children are required to stand upright, with toes separated, heels hips And two shoulders against the wall, with the line of sight forward, use a triangle ruler to make the wall and the head baffle form a 90 degree angle. Then calculate the number of centimeters that the height increases each year, that is, the growth rate. The average length of a child at birth is 50 cm. In the first half of the year after birth, the average length increases by about 2.5 cm per month, and 1.5 cm per month in the second half of the year. The growth rate slows down in the second year. By the age of two, the average length is about 85 cm. The length of children aged 2-12 can be roughly calculated according to the following formula: length (cm)=age × 7+70. 3. The development of teeth can reflect the development of bones. The deciduous teeth begin to grow 4 to 10 months after birth. If the teeth have not been produced for 12 months, it is a delay in tooth production. Generally, the deciduous teeth should be produced when they are 2 and a half years old. Children usually begin to produce permanent teeth at the age of 6 years, and begin to replace primary teeth at the age of 7 to 8 years. If the teeth are produced or replaced too late, it often reflects the backward bone development.
If parents or teachers suspect that a child's growth is slow, they should take him to the hospital for further examination as soon as possible, so that problems affecting the child's growth can be found early and effective treatment can be carried out.
What factors can lead to children's growth disorder?
In fact, the growth and development of children are affected by many factors, the most important is the genetic factor, which determines the growth and development potential of children, and at the same time, this potential is affected and regulated by a variety of external factors. Understanding these specific factors will help parents find defects and problems in their children's growth and development, which is of great significance to ensure their children's normal growth and development.
1. Genetic factors: The growth and development of children are affected by the genetic factors of both parents. Characteristics, potential, tendency, skin and hair of children's growth and development colour , facial features, height, sexual maturity and susceptibility to diseases are all related to heredity. Some hereditary metabolic defects, endocrine disorders, chromosome aberrations, etc. can seriously affect the growth and development of children. 2. Gender factors: boys and girls have their own characteristics in growth and development. Generally, girls are smaller in average height (length) and weight than boys of the same age. Girls' language and motor development are slightly earlier than boys'; Girls' puberty is also earlier than boys', while boys' physical development is significantly higher than girls' due to the longer duration of puberty. Therefore, the evaluation of children's growth and development level should be conducted according to the male and female standards respectively.
3. Endocrine factors: children's growth and development are regulated by various hormones in the body, for example, insufficient growth hormone will lead to short stature; Thyroid hormone deficiency can cause physical dwarfism and mental retardation.
4. Maternal condition: Viral infection of the pregnant mother in the early pregnancy will cause congenital malformation of the fetus; Severe malnutrition of pregnant women can cause abortion, premature delivery, fetal physical growth and brain growth retardation; If the pregnant mother is affected by certain drugs, radiation, mental trauma, etc., the fetal development will be blocked. If the fetus develops abnormally in utero, it can affect the growth and development of children.
5. Nutritional factors: Adequate and reasonable nutrition is the material basis for children's growth and development, and is also an extremely important factor to ensure children's healthy growth. If children are malnourished in the fetal period, not only their physical growth is backward, but also their brain development is affected. The severe malnutrition within two years of birth will restrict the growth of body weight and height, as well as the immune, endocrine and neural functions of the body. The younger the age, the more affected by nutrition.
6. Environmental factors: good living environment, such as sufficient sunshine, fresh air, clean water source, healthy living habits and scientific nursing, correct upbringing and physical exercise, and perfect medical care services are all important factors to ensure the optimal growth and development of children.
7. Disease factors: acute infection often causes weight loss in children; Long term chronic diseases will affect the development of weight and height; Congenital diseases such as congenital heart disease have more obvious effects on growth and development.
The growth and development of children is the result of the interaction between heredity and environment. Although heredity determines the growth potential of children, the acquired environmental factors determine whether the growth potential can be fully exerted. Therefore, for children with growth and development disorders, we can timely intervene through the following measures to give full play to the growth potential endowed by nature.
For non organic FTT, 50%~70% of children's weight is higher than the third percentage when they are over 1 year old. Cognitive function, especially language function, is about 50% lower than normal. Children who suffer from FTT before 1 year old are more dangerous, especially those who are less than 6 months old. At this stage, the brain develops fastest and has a greater impact on intelligence. General behavior problems are mainly related to diet, such as pickiness, Half of the cases of slow eating and other behavioral or personality abnormalities can be confirmed by teachers
The purpose of treatment is to provide enough food and good environment to promote growth and development. Nutritional diet includes enough heat calories to meet growth needs (150% more than normal children of the same age are provided daily). Patients also need medical assistance and social support. Hospitalized children cannot distinguish organic FTT and non organic FTT based on weight growth, because if there is enough nutrition, All children can grow. Some non organic FTT children often lose weight in hospital, suggesting that it is better to be separated from their parents even if their parents do not care enough
The possible diseases of children with organic FTT or mixed FTT should be treated as soon as possible. For children with obvious non organic FTT or mixed FTT, treatment includes providing education and emotional communication, correcting problems affecting the relationship between parents and children, and long-term social support and psychotherapy are also necessary
Before discharge, the children should develop a discharge treatment plan, and the relevant personnel of the hospital, the follow-up personnel after discharge, family doctors, etc. should participate together. Finally, the suggestions should be sent to each participant in writing
For some cases, the children must be placed in the care center. If the children want to return to their parents, they must provide feeding skills training and psychological counseling for their parents to understand their parents' ability to support and living conditions, rather than being discharged only according to the length of hospital stay
Many undergrown children are closely related to nutritional deficiency, scientific feeding and reasonable collocation Very important. Some parents have a misconception about nutrition. They think that strengthening nutrition is to eat more chicken, duck, fish and meat, instead of eating or eating less food. In fact, too much protein intake not only increases the burden of liver and kidney, but also easily causes indigestion and constipation, and also inhibits children's appetite. Some children suffer from obesity after excessive nutrition, which is easy to lead to precocious puberty and eventually make them short. Therefore, while ensuring adequate quantity, we should also pay attention to the reasonable collocation and diversification of diet, that is, coarse and fine collocation, meat and vegetable collocation, not picky, not partial to food. Don't eat too many snacks to affect the intake of important nutrients. Parents should train their children to develop good eating habits from childhood. Physical activity is the most effective way to promote physical development and enhance physique. Exercise can stimulate the secretion of growth hormone, promote metabolism and increase appetite. Children and adolescents often engage in sports, which can promote bone growth, make bones grow longer and thicker, and increase bone density. Regular exercise can also thicken muscle fibers and improve muscle strength, speed and tolerance. Exercise can also consume excess fat and prevent obesity during the rapid growth period.
The secretion of growth hormone, which can promote the growth of the human body, is about 3 times that in the sleep state than in the awake state. Therefore, ensuring adequate sleep is conducive to growth. The muscles relax during sleep, which is conducive to joint and bone extension. In order to make children have enough sleep, we should pay attention to developing good sleep habits. For children in rapid growth period, it is very important to arrange learning, exercise, sleep and rest reasonably.
Actively prevent and cure diseases
Generally, the impact of acute diseases on growth is temporary, especially in the case of good nutritional status, which can be quickly recovered. But long-term diseases such as chronic infection, chronic hepatitis, chronic nephritis, asthma, heart disease, anemia, etc. can affect Growth and development 。 In addition, major diseases, such as chromosome abnormalities, endocrine diseases, bone and cartilage development disorders, can cause children whose height is significantly lower than that of their peers, which is called pathological dwarfism in medicine. Therefore, actively preventing and treating diseases is of great significance to children in their growing period. Through early diagnosis and treatment, the growth damage caused by some diseases can be completely or partially recovered. 
