What Are the Different Types of Growth Disorders?

The following two points must be taken into account when adopting the above definition: According to the law of normal distribution, 3% of normal children should weigh less than the third percentile (but most people who weigh less than the third percentile do (Growth disorder). If growth disorder occurs, the ideal weight calculated based on height must be corrected with the expected height (the expected height is determined according to the height growth curve), not the actual height.

Growth disorder

Weight continues to be below the third percentile of the corresponding age; progressive weight loss to below the third percentile; weight is less than 80% of the corresponding height age weight; or whether it is below the third percentile The percentile, but according to the growth curve originally determined by the child, its expected growth value declines, which is a growth disorder.

Basic symptoms of growth disorders

Growth disorders

Among patients with growth disorders, about 3% to 5% are sent to health centers, and 1% are sent to hospitals for treatment.

Etiology and Pathophysiology

The physiological basis of growth disorders (FTT) caused by any cause is related to malnutrition.

Organic FTT refers to growth disorders caused by acute and chronic diseases that interfere with normal nutrient intake, absorption, metabolism or excretion, or increased energy requirements (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 children with FTT cannot find the cause of growth inhibition. The lack of food may be due to poverty, lack of feeding skills, not Appropriate milk formula, etc., such as excessive dilution of milk powder due to economic difficulties, or insufficient milk supply due to maternal fatigue, malnutrition, etc.

In most cases, the psychological factors of non-organic FTT are related to hospitals and health education. The lack of environmental stimulation in infants can become frustrated, pessimistic, and anorexia. The lack of stimulation in children with non-organic FTT may be due to caregivers (usually (Mother) her own depression, pessimism, lack of parenting skills, and concerns about not being able to fulfill her care responsibilities. Other factors in the environment, such as marriage crisis, financial difficulties, etc. are also important.

However, mother's care failure is not enough to explain the non-organic FTT. The personality and reaction ability of the child also affect the mother's emotions. Sexual FTT comes in different forms, with severe types of children suffering from illness. Even the most capable parents have a challenge in feeding their infants. Another situation is when a basically normal child is taken care of by a mentally ill parent who lacks sufficient The socio-economic basis of the two extremes is that the mother and the child are incompatible. In this case, the child's needs cannot be fully met from the mother.

In mixed FTT, there are both organic and non-organic FTT causes. Doctors must identify the relative role of each cause in FTT. Mixed FTT often occurs in preterm infants, and growth disorders occur in later childhood. Patients may have certain physiological defects, but cannot explain the current growth disorders, such as cleft palate has been repaired, sucking difficulties caused by neurological reasons, and annoyance to caregivers should also be investigated.

Other growth disorders

In addition to the symptoms of growth disorders that continue to weigh less than the weight of the corresponding age, there are other growth disorders such as short stature, stunted development of the sexual organs and second characteristics, and so on.

A small number of children have stopped growing at the age when they should be developing, and no corresponding sexual development changes have occurred. This is called growth delay and growth disorders. Children with delayed and growth disorders are short in stature, with poorly developed sexual organs and secondary characteristics, but there is still a certain difference in their essence. Growth delay means that although the child's growth and development are delayed, they can eventually reach normal levels. Growth disorder refers to the interruption of the normal growth and development process, and can no longer develop without treatment.

Some children are hereditary dwarf, which is not considered a growth disorder. These children are completely healthy and normal. Their short stature is caused by family genetic factors. No treatment is needed for them. Use growth hormones and androgens to Stimulating growth is also completely ineffective because the hormone levels of themselves and their parents are completely normal.

There are two most common endocrine factors that affect growth and development, namely growth hormone deficiency and thyroid hormone deficiency. Growth hormone deficiency is mostly idiopathic, and only a few are secondary to intracranial lesions, such as craniopharyngioma. Most of these tumors are benign and can be surgically removed. These children are short and severely manifested as dwarf, but their intelligence is generally in the normal range. The use of growth hormone in these children can achieve good results, but the treatment period is very long (from childhood to adolescence, full treatment is required, 2-3 intramuscular injections a week), until the growth naturally stops. If the child is also accompanied by other pituitary hormone deficiency, it should be treated at the same time.

Lack of thyroid hormones also stops 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 poorly differentiated brain cells) and stupid faces. If insufficient thyroid hormone secretion occurs in the fetal stage where brain nerve cells rapidly differentiate, the condition is more severe. Therefore, in recent years, conventional screening methods for the determination of blood thyroid hormones in newborns have been used abroad in order to obtain good results in early diagnosis and treatment.

The adverse effects of lack of pituitary gonadotropin on growth are also common. In girls, ovarian dysplasia and secondary sexual characteristics are lacking, but most of the intelligence is normal. The gonadotropin levels in these girls' adolescent urine are still very low, and the boys cause secondary testicular dysfunction. These boys have delayed development of their reproductive organs and secondary sexual characteristics, and their penis such as baby type, pubic hair, and armpit hair are scarce No beards. Due to insufficient testosterone secretion, the child's muscles are weak, the chest and shoulders are narrow, the epiphyseal healing is significantly delayed, and the long bones continue to grow. As a result, the limbs are longer than normal people, showing a characteristic thin and tall body.

Growth disorder diagnosis

Due to the nature of the disease, organic FTT can occur in children of any age. Most children with growth disorders appear within 1 year of age, and can even appear before 6 months.

Weight is the most sensitive indicator of growth disorders. A reduction in the growth curve indicates that the patient has more severe chronic malnutrition. When protein / energy is inadequate, brain development is most affected by malnutrition. Therefore, head circumference growth declines occur later, and Very severe and chronic malnutrition is often indicated.

In general, when a patient with growth disorder is found, one should know the medical history (including dietary history --- Table 262-2), carefully ask about dietary conditions, provide dietary advice, and often monitor the weight of the child. If the weight gain of the child is still not disturbing Satisfied, you should be hospitalized for the necessary observations and inspections. Whether it is medical history, physical examination, simple clinical features, it is difficult to identify organic FTT in non-organic FTT. Before establishing a non-organic FTT diagnosis, the doctor should FTT patients look for potential clinical manifestations, attention to personality, family characteristics, and other socio-psychological-related FTT. Assessments are best performed by multidisciplinary experts, including physicians, nurses, nutritionists, specialists in child development, and social workers Psychoanalysts and psychologists. Whether it is an outpatient or inpatient, surveys of pediatric feeders, caregivers and parents are essential.

It is necessary to work with parents to investigate the cause of the growth disorder. This will get their respect and cooperation. Avoid blaming them in the investigation because these parents may be psychologically frustrated because they are unable to feed their children. May have guilty feelings. Staff should be welcomed by them, support parents to try their children's feeding methods, provide toys and make ideas to promote parents and children to play and communicate together. Staff should not be irresponsible or other mistakes of parents No comment on FTT.

Staff praises parents for their correct behavior and sense of responsibility, and reports care negligence or abuse to the Social Services Department. In many cases, it is important to take more preventive measures to meet the family's needs for children's education. Childcare methods, parent participation in parent education classes, etc.

During the hospital stay, carefully observe the relationship between the child and other people, and record self-stimulating behaviors, such as shaking, bumping his head. Children with non-organic FTT are often described as highly vigilant and very careful in contact with people. If they can communicate, Prefer to communicate with inanimate objects. Although children with non-organic FTT are more common in neglected families than scolded ones, the evidence of abuse is still closely monitored. Developmental levels should also be performed on children Screening tests, if necessary, for more complex inspections.

FTT tests recommended by most experts are: CBC, ESR, urine analysis (including concentration and acidification ability), BUN or serum creatinine levels, urine culture, stool tests (including pH, reducing substances, color, properties and odor). Many laboratory tests often have no results. According to the local epidemic situation of the disease, blood lead level measurement, HIV antibody detection, intradermal tuberculin test are selected. If the child has obvious nausea and vomiting, the electrolyte concentration can be determined Thyroid hormone levels should be measured when height gain is more affected than weight gain. When there are repeated episodes of respiratory disease with indigestion and hepatomegaly, cystic fibrosis should be examined. Fever, nausea, and vomiting. Examinations related to infections should be performed. Radiology departments should check for diseases with anatomical or functional abnormalities, such as pyloric stenosis, gastrointestinal reflux, etc.

Clinical diagnosis So how to detect if children have growth disorders early? The following methods will help you:

Compare with the height of other children of the same age and gender. If the middle-aged child in the class becomes a short child each year, it indicates that the child grows more slowly than other children.

Measure height: Measure every six months to one year according to age. Infants and young children can take a lying position and measure with a tape measure. Children over 3 years old can nail a tape measure to the wall to measure. Children are required to stand upright with their toes separated, the heels, buttocks and both shoulders against the wall. Look forward. Use a triangle ruler to make the wall and head bezel. Ninety degree angle. Then calculate the number of centimeters of height increase per year, that is, the growth rate. The average length of a child at birth is 50 cm. The average length of the child in the first half of the month increases by approximately 2.5 cm, and in the second half of the month it increases by 1.5 cm. The rate of increase slows down in the second year. Children's body length from 2 to 12 years old can be roughly calculated according to the following formula: body length (cm) = age × 7 + 70.

The development of teeth can reflect the development of bones. Baby teeth will begin to grow from 4 to 10 months after birth. If the teeth have not been teethed for 12 months, the teething will be delayed. Generally, the teeth should be full at the age of 2 and a half. Children generally begin to have permanent teeth around the age of 6 and begin to replace deciduous teeth around the age of 7 to 8 years. If teething or tooth replacement is too late, it often reflects skeletal development.

If a parent or teacher suspects that a child is growing slowly, he or she should be taken to the hospital early for further examinations so that problems that affect the child's growth and development can be detected early and treated effectively.

Causes of growth disorders

What factors can cause growth disorders in children?

In fact, children's growth and development are affected by many factors, the most important of which is genetic factors. It 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, and is of great significance for ensuring their children's normal growth and development.

Genetic factors: Children's growth and development are affected by genetic factors of both parents. Children's growth and development characteristics, potential, trend, skin, hair color, facial features, stature, sexual maturity, and susceptibility to diseases are all related to genetics. Some hereditary metabolic defects, endocrine disorders, and chromosomal aberrations can seriously affect children's growth and development.

Gender factors: Boys and girls have their own characteristics of growth and development. Generally, the average height (length) and weight of girls are smaller than boys of the same age. The language and motor development of girls are slightly earlier than those of boys; girls' puberty also precedes that of boys, and because boys have a longer adolescence, their physical development eventually surpasses that of girls. Therefore, the assessment of children's growth and development should be carried out according to male and female standards.

Endocrine factors: Children's growth and development are regulated by various hormones in the body. For example, insufficient growth hormone can lead to short stature; thyroid hormone deficiency can cause short stature and mental retardation.

Pregnant mother's condition: Viral infection of pregnant mother in early pregnancy can cause congenital malformation of the fetus; severe malnutrition of pregnant mother can cause miscarriage, premature birth and physical growth of the fetus, as well as delayed brain development; if the pregnant mother is exposed to certain drugs, radiation Effects such as radiation and trauma can cause fetal development to be hindered. If the fetus develops abnormally in the uterus, it can affect the growth and development of children.

Nutritional factors: Sufficient and reasonable nutrition is the material basis for children's growth and development, and it is also a very important factor to ensure the healthy growth of children. If children are malnourished during the fetal period, not only their physical growth is backward, but their brain development is also affected. Severe malnutrition within two years of birth can limit weight, height growth, and poor regulation of the body's immune, endocrine, and neurological functions. The younger the age, the greater the impact of nutrition.

Environmental factors: a good living environment, such as sufficient sunlight, fresh air, clean water, healthy living habits and scientific care, correct parenting and physical exercise, and comprehensive medical care services are all to ensure that children grow optimally. An important factor in status.

Disease factors: Acute infection often causes weight loss in children; long-term chronic diseases can affect the development of weight and height; congenital diseases such as congenital heart disease have a more significant impact on growth and development.

Children's growth is the result of genetic and environmental interactions. Although genetics determines the growth potential of children, the acquired environmental factors determine whether the growth potential can be fully utilized. Therefore, for children with developmental and developmental disorders, we can intervene in time through the following measures to fully realize the growth potential conferred by them.

Growth disorder prognosis

For non-organic FTT, 50% to 70% of children's weight is higher than the third percentage when they are more than 1 year old. Cognitive function, especially language function, is about 50% lower than normal. FTT before 1 year old Children are more dangerous, especially children less than 6 months old. At this stage, brain development is the fastest and has a greater impact on intelligence. General behavior problems are mainly related to diet, such as picky eaters, slow eating, and other behavioral or personality disorders. Half of these cases can be confirmed by the teacher.

Growth Disorders Treatment

The purpose of treatment is to provide enough food and a good environment to promote growth and development. The nutritional diet includes sufficient calories to meet growth needs (providing daily calories of more than 150% of normal peers). Patients also need medical help and social support Hospitalized children cannot be distinguished between organic FTT and non-organic FTT based on weight gain, because all children can grow if there is sufficient nutrition. Some children with non-organic FTT often lose weight in the hospital, suggesting that Inadequate parental care is also better than separation from parents.

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 to correct the impact on the relationship between parents and children. Problems, long-term social support and psychotherapy are also required.

Patients should develop a discharge treatment plan before discharge. Relevant personnel of the hospital and follow-up personnel after discharge, family doctors, etc. should participate together. Finally, it is recommended to send it to each participant in written form.

In some cases, the child must be placed in a care center. If the child wants to return to his parents, he must provide the parents with feeding skills training and psychological counseling to understand their parenting ability and living conditions, rather than just being discharged based on the length of hospital stay.

Growth disorder prevention

Growth disorders balanced nutrition

Many undergrowth children are closely related to nutritional deficiencies, and scientific feeding and reasonable matching are very important. Some parents have a nutritional misconception that strengthening nutrition means eating more chicken, duck, fish, and meat, but not eating or eating less food. In fact, too much protein intake not only increases the burden on the liver and kidneys, but also easily causes indigestion and constipation, and also suppresses the child's appetite. Some children cause obesity after excess nutrition, which is likely to cause precocious puberty, and eventually make them shorter. Therefore, while ensuring sufficient amounts, we must also pay attention to the reasonable mix and diversification of the diet, that is, the combination of thickness and vegetarian diet, not picky eaters, not partial eaters. Do not eat too much snacks and affect the intake of important nutrients. Parents should train their children to develop good eating habits.

Growth disorder physical exercise

Physical activity is the most effective way to promote physical development and physical fitness. Exercise can stimulate growth hormone secretion, promote metabolism, and increase appetite. Children and adolescents often engage in sports, which can promote bone growth, make bones longer and thicker, and increase bone density. Regular exercise also thickens muscle fibers and increases muscle strength, speed, and tolerance. Exercise can also consume excess fat and prevent obesity during the rapid growth period.

Growth disorders, adequate sleep

The growth hormone that promotes the growth of the human body is about three times more secreted during sleep than when awake. Therefore, ensuring adequate sleep is conducive to growing taller. Muscles relax during sleep, which helps joints and bones stretch. In order to make children have enough sleep, we should pay attention to developing good sleep habits. For children who are growing fast, it is important to arrange learning, exercise, sleep and rest appropriately.

Growth disorders actively prevent disease

Generally, the effects of acute diseases on growth are temporary, especially when the nutritional status of the body is good, it can recover quickly. However, chronic diseases such as chronic infection, chronic hepatitis, chronic nephritis, asthma, heart disease, and anemia can affect growth and development. In addition, major diseases such as chromosomal abnormalities, endocrine diseases, and bone and cartilage development disorders will cause significantly lower height than their peers, and are medically referred to as pathological dwarf. Therefore, actively preventing and controlling diseases is of great significance to children in the growing period. Through early diagnosis and treatment, the growth damage caused by some diseases can be completely or partially recovered.