Short Height and Treatment in Children
Liv Hospital Child Endocrinology and Metabolic Diseases Specialist Prof. Dr. Cengiz Kara answered questions about short stature and treatment of children.
What is short stature?The definition of short stature varies from one society to another. If a person's height is in the bottom 3 percent of the society according to the standards of the society he / she lives in, he / she is defined as a short person. To understand this definition, let's think of a community of 100 people, and these people will be in the order of length to length. The first three people on the long side, 94 people between the norms of the norm and the last three people on the short side of these 100 people constitute the shortest of the society.
What is the incidence of short stature in Turkey?According to the definition of short stature, short stature (stunting) can be detected at about 3% when any society is screened for short stature. Essentially height - weight scans are made to assess the nutritional status of the population. In terms of community screening, shorter length is an indicator of chronic nutritional deficiency. The higher the proportion of short (stunted) children in a society, the more common is the lack of nutrition. Hacettepe University Institute of Population Studies, Development and Turkey carried out with the contribution of the Ministry of Health Demographic and Health Survey (DHS) data sources in terms of 5 years is a good nutritional status of children under. According to the latest 2013 TDHS data, the short stature of children under 5 years of age is approximately 10%, and about one-third of these children have serious short stature. In rural areas, the short stature was 15 percent while in urban areas it was 8 percent. Regional differences in short lengths are noteworthy. While the Aegean region has the lowest shortest ratio with 5 percent, the rates are increasing to the east and the rate reaches 18 percent in Northeast Anatolia.
We have regional data on school-age children. For example, school children between 6-16 years of age in Istanbul had a short stature rate of 5.7 percent. This rate is 4.4 percent in the 14-18 age group in Manisa. However, in Mersin, around 12 years of age, children had a short stature of 11 percent. In conclusion, the lower the socioeconomic level of the evaluated population, the higher the rates of short stature. In underdeveloped countries, these rates may increase up to 50%. Although there is a slight decrease in the short stature compared to TDHS 2008 data (12 per cent short stature), the nutritional deficiency problem still continues in the low-socioeconomic levels of our country.
How is the distinction made between normal and disease-related shortnesses in children?In this distinction, the most important variable for childhood is growth rate. Growth rate is the amount of elongation in a certain period of time, for example 6 months or 1 year. Children in the pre-adolescent period grow an average of 5-6 cm per year. If a child's growth rate is reversed according to their peers, there is growth retardation. If a short child is generally healthy and growing at normal speed, this is called normal shortness. Family and structural shortages are included in this group. There is always an underlying cause of shortness of growth retardation and is called pathological brevity. Separation over the growth rate requires a follow-up of 6-12 months, which may lead to a loss of time in terms of identifying an underlying serious problem. However, if the child's height is measured and monitored on a growth curve in every examination, growth retardation may be noticed early on by observing the shift down the curve. Even if the child's height is normal, it is necessary to investigate the disease if there is growth retardation.
If the child's old growth curve is unknown and shortness is detected for the first time, another criterion for the separation of normal and diseased shortness is the degree of shortness. If the height of the child is 1 percent below the social standards, there is a short stature. Serious short stature occurs due to diseases, not considered normal.
What are the reasons for serious short stature?
- Short stature and causes of growth retardation;
- Lack of nutrition
- Chronic diseases
- Rickets and other bone diseases
- Small (SGA) childbirth by gestational week
- Genetic disorders
- Contains endocrine diseases.
The most common endocrine causes are thyroid and growth hormone deficiency. The most common cause of growth retardation and short stature in children all over the world is nutritional deficiency. This condition, also called malnutrition, is caused by insufficient food intake in developing countries. In addition to providing adequate and balanced food intake in the treatment of nutritional shortness, high energy feeding products may be needed. In developed countries, nutritional deficiencies are mostly caused by chronic diseases that impair nutrient absorption or increase energy consumption. For example, the short stature may sometimes be the first and only finding in celiac disease, which disrupts nutrient absorption from the small intestine and causes growth retardation. In children with celiac disease, a gluten-free diet can lead to normal growth of the bowel damage.
What are effective foods and sports activities in height growth?The most important feature that separates children from adults is growth. The most important factors affecting growth are genetic structure, nutrition, hormones and diseases. Adult height is determined by 80 percent genetic structure. Because the child takes his genes from his parents, he has a height compatible with the parents' height. Children can reach a height between 5-10 cm below the mean height of the parents. This means that differences in the genomic structure of girls or brothers are very close to each other and possible up to 10-20 cm in length. This difference creates environmental factors such as nutrition and sports.
The most important environmental factor affecting growth in all ages, especially in infancy, is nutrition. The child must receive sufficient amounts of protein, fat, carbohydrates, liquid, vitamins, minerals and trace elements in a balanced manner for normal growth. Nutrition is made to meet these requirements. In the first six months of life, breastfeeding meets the needs of the baby perfectly and provides the best growth. Early onset of ready-to-eat foods may pose a risk for obesity, while improper preparation, for example, foods given by over-dilution may lead to malnutrition.
Definitions such as lengthening food or herbal products are not generally correct. It should be emphasized once again that normal meals are provided if the meals offered to the child contain enough calories and protein. Children's consumption of meat, fish and other animal products is essential for good growth. Sometimes the diet contains enough calories and protein, but iron and zinc minerals, or other trace elements and vitamins may be inadequate in the intake. In such cases, mineral and vitamin supplements can accelerate growth. Sports activities in well-nourished children also stimulate growth by stimulating bone growth. Jumping, basketball, volleyball, sports such as jump rope is the main activity is more stimulating growth in children.
Which treatment options of short stature in children are available?It is essential to identify and treat the underlying cause in a boy with short stature. The hormone deficient in endocrine diseases should be replaced. Thyroid hormone is given to children with hypothyroidism. Growth hormone treatment in children with growth hormone deficiency allows normal growth and the child to reach adult potential according to his / her potential.
On the other hand, for a group of diseases that make short stature, treatment for the cause cannot be applied. When children with this type of disease do not intervene, adult lengths remain short. Two of the most common examples of this condition are Turner syndrome with a chromosomal disorder and small children with SGA. This has been demonstrated in many internationally conducted long-term studies in which growth hormone therapy has been successful despite the lack of growth hormone in children. Therefore, the US Drug and Food Administration (FDA) and the European Union Medicines Agency (EMA), Turner syndrome and SGA have approved the treatment of growth hormone in children.
Turkey has licensed the use of growth hormone drug approval for this disease. However, in our country, there are difficulties in the repayment of growth hormone treatment for the treatment of short stature related to diseases other than growth hormone deficiency. In the case of FDA and EMA approved indications such as Turner syndrome and SGA by the Social Security Institution, the treatment of growth hormone treatment is important for the treatment of children with such severe shortness. Treatment options for children living in developed countries should be provided to our children.