Major Factors Regulating Growth In A Healthy Child

Many factors contribute to a child’s overall growth. However, nutrition, hormones and the growth potential a child inherits from their parents are the major factors regulating growth in a healthy child. Chronic illnesses such as diseases of the kidneys, liver or heart, as well as chronic use of certain medications can delay a child’s growth.

GROWTH CHARTS

Doctors use growth charts to determine if a child is growing normally with respect to their height and weight. Since there is a range of normal heights at any particular age the growth charts are composed of curves which represent percentiles of growth.

HOW TALL SHOULD MY CHILD BE?

Which percentile a child should be growing at is primarily determined by their parent’s height. The first question to answer when evaluating a child for delayed growth is are they growing on a percentile curve that is appropriate or expected for their family. In general we expect short parents have short children and tall parents have tall parents.

The height potential a child receives from their parents can be estimated by calculating the midparental height (MPH). On average adult males are 5 inches taller than adult females. The formula for MPH adjusts the parent’s height either up or down by 5 inches depending on whether the child is a boy or girl. The MPH is calculated using the parent’s height in inches.

Girls:	MPH = (Dad’s height – 5") + Mom’s height 2
Boys:	MPH = (Mom’s height + 5") + Dad’s height 2
As an example if mom is 5'4" (64") and dad is 5'10" (70") their daughter’s MPH would be:
MPH =	(70"-5") + 64" = 2	65" + 64" = 2	129" 2	= 64½" (5'4½")
And their son’s MPH would be:
MPH =	(64" + 5") + 70" = 2	69" + 70" = 2	139" 2	= 69½" (5'9½")

The MPH is then plotted on the right hand of the growth chart.

In our example then a MPH of 5'4 ½” for a female is at the 50% percentile,
Likewise the MPH of 5'9½" for a male is the 50%. On average for this family their sons and daughters should be growing along the 50th percentile line. Just as there is range of normal heights for children at any age there is a range of heights amongst brothers and similarly amongst sisters.

If your child’s height is on a growth channel lower than the predicted ranges their growth is most likely not appropriate for your family.

In our example family they have a five year daughter (A) who is 42" and a 12 year old daughter (B) who is 54¼" The five year old’s height is at an appropriate percentile for the family. In contrast the 12 year old daughter is shorter than expected for the family even though her height is in the so called normal range of the growth chart.


HORMONE CAUSES OF DELAYED GROWTH

There are three groups of hormones which are necessary for a child to grow. Growth hormone and thyroid hormone are important growth factors from birth until a child reaches their adult height. The production of the sex steroids testosterone and estrogen during puberty, also influence growth. A deficiency of any of these hormones will result in a delay of growth. These deficiencies can be present at birth or develop throughout childhood and adolescence. Generally with growth hormone deficiency there are very few other signs in a child except for poor growth. Children with thyroid hormone deficiency aside for having poor growth may complain of being tired, weak, feeling colder than others, having constipation, dry skin and coarse hair. The possibility of a deficiency of sex steroid production should be raised if a boy has not shown any signs of puberty by age 14 or a girl by age 13.

THE GROWTH EVALUATION

The initial evaluation of child with poor growth includes reviewing their previous growth pattern, obtaining a history about their family’s heights and looking for signs of hormone deficiencies, chronic illness of genetic syndromes associated with delayed growth. Growth records form birth to the present can provide an enormous amount of information as to an underlying cause of the child’s poor growth. Many times a completed growth chart is more valuable than laboratory tests. Often multiple sources have to be tapped to find the complete growth history. This may include your child’s doctor’s office, baby books you may have kept and even the marks on the doorframe in your home where you have followed your child’s growth over the years. After reviewing this information, special tests may be recommended including blood tests to measure hormone levels, assess the function of your child’s kidneys, liver, intestines and assess their nutritional status. Usually we obtain an X-ray of the hand called a bone age to assess the rate at which your child’s bones are maturing.

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Health Cover For Kids Up To 14 Years In Govt Schools

NEW DELHI: All children below the age of 14 studying in Delhi schools – government-run, government-aided, MCD/NDMC and cantonment board schools – will now get free treatment and compulsory check-ups.

In the budget for 2011-12, the Delhi government has announced a new scheme – 'Chacha Nehru Sehat Yojana' – which aims at providing free healthcare to almost 27 lakh school-going children. After implementation of Right to Education, this is going to be the biggest leap for the adoption of
'Right to health for all children', said chief minister Sheila Dikshit.

She said an initial corpus of Rs 100 crore has been proposed for this particular scheme which can be further assessed and increased according to future requirements. The total outlay for the health sector in this year's budget has increased to Rs 1801 crore – 13% of the total outlay – from last year's Rs 1,243 crore.

The focus of this year's health budget is on the augmentation of existing health infrastructure and starting new schemes to improve services – for example, starting of specialized clinics for diabetics and kidney transplant at Guru Tegh Bahadur Hospital in Shahdara and a health insurance scheme for EWS. Two new medical colleges are also going to be started in Ambedkar Nagar and Dwarka.

The government's plans also include starting of a 500-bedded ward block at GTB Hospital, construction of Phase II of the Institute of Liver and Billary Sciences and setting up of more hospitals at Ambedkar Nagar, Burari and Dwarka. These projects had been mentioned in the last budget and even the year preceding that. An outlay of Rs 167 crore is proposed for construction of new hospital buildings at Sarita Vihar, Sirapur, Keshavpuram, Chattarpur and Bapraula and maternity and child hospitals at Molarbandh and Jhatikra.
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Now, A Diet For Exams

TaMany schools have sent recipes to parents on what they need to feed the kids during exams. In the dos and don’ts list, schools have detailed the greens and blues (fluids) required to keep stress away.

Usha Mohan, an educationist and the principal of India International School, said, “We insist on plenty of fluids and a healthy breakfast. We have suggested nutritious meals with salads and sprouts. We have also asked students to stay away from junk, outside food, cold and oily stuff, and sweets.”

At the Green Wood High School, the management has come up with a new concept. Something, they say, if seriously followed, could help students wade through the exams. "We came up with the concept called DREAM - D (drink lots of water) which keeps your mind fresh and healthy; R (regular sleep); E (eat healthy food); A (attitude) for a positive attitude during exams; and M (meditation) like yoga that can give you peace of mind. It's very important to have the support of parents and have a positive atmosphere at home. Students must have at least 15 minutes of outdoor activity even during exams. It helps them exercise and relax their muscles. Though there is no particular timing for studies, the best time is before sunrise,” said Manas, an educationist and trustee of the high school.

Liquids help you to relax and be calm, while spicy and salty food can lead to sluggishness, he said.

“Green, leafy vegetables, fruits, salads and pulses should be encouraged during examinations to reduce the stress and strain.
But make sure not to overexert or strain. A short walk, a glass of water or just glancing through magazines can help you de-stress. One of the parents should keep an eye on the children during the exam time and restrict them from watching television,” Shenoy, vice-principal of Innisfree House School, said.

The doctors, however, didn't think much of a special diet. “One need not have a special diet during exams. All that running around is really not necessary. What students and parents must actually focus on is having regular food. Just skip the junk food," Dr Ramesh, district health officer, said.

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Economic Growth 'Not Linked To Reduction In Child Undernutrition In India'

A new study has found that economic growth in India has no automatic connection to reducing undernutrition in Indian children.

Researchers at the Schools of Public Health at University of Michigan and Harvard University said further reductions in the prevalence of childhood undernutrition are likely to depend on direct investments in health and health-related programs.

Malavika Subramanyam, S V Subramanian and colleagues collected data from the National Family Health Surveys conducted in India in 1992-93 (28,066 children), 1998-99 (26,121 children) and 2005-06 (23,139 children), which use stratified, representative samples of the population from every state of India.

They used the measurements-weight-for-age, height-for-age, and weight-for-height-in these surveys to classify individual children's nutritional status as underweight, stunting or wasting, respectively, as per the WHO Child Growth Standards.

The study reported that the prevalence of underweight decreased from 49.1 percent in 1992-93 to 43.8 percent in 1998-99 to 40.2 percent in 2005-06.

Stunting prevalence also decreased while the prevalence of wasting decreased only marginally from 24 percent in 1992-93 to 22 percent in 2005-06. Meanwhile, during the study period, the Indian economy grew at an annual rate of 7 -9 percent.

Further, there was substantial variation between states in each of the measures of undernutrition, as well as economic growth, and this enabled the authors to examine whether changes in state economic growth were associated with a reduction in the risk of a child being undernourished in a given state.

The authors found that state economic growth was not associated with the risk of underweight, stunting, and wasting.

"We failed to find consistent evidence that economic growth leads to reduction in childhood undernutrition in India," said the researchers.

"Direct investments in appropriate health interventions may be necessary to reduce childhood undernutrition in India," they concluded.

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