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Linear growth retardation

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Linear Growth Retardation (what are the causes, how to detect by using growth chart, diagnosis, treatment and others related to it).

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Linear growth retardation

  1. 1. Linear Growth Retardation
  2. 2. Linear Growth Retardation Linear growth retardation (stunting) is prevalent (10-80%) in developing countries. It takes place between 6 and 18 months of age and can be characterized by the delayed onset of the childhood phase of growth.
  3. 3. Epidemiology The global prevalence of stunting in children younger than 5 years was estimated to be 26% (95% confidence interval [CI], 24–28%) for 2011, the most recent data (UNICEF-WHO-The World Bank, 2012). The number of stunted children in that year was estimated to be 165 million. The prevalence of stunting has declined from 40% in 1990, with an average annual rate of reduction of 2.1%. The prevalence of stunting varies substantially by world region (Fig. 2.1), with the highest prevalence in Africa and South-Central Asia (which includes India).
  4. 4.  Growth curve in a male with intrinsic
  5. 5. Signs & Symptoms  The umbilical cord is often thin and dull instead of thick and shiny.  If they have certain forms of dwarfism, the size of their arms or legs may be out of normal proportion to their torso.  If low levels of the hormone thyroxine are causing their growth delay, they may experience a loss of energy, constipation, dry skin, dry hair, and trouble staying warm.  If they have low levels of GH, it can affect the growth of their face, causing your child to look abnormally young.  If their delayed growth is caused by stomach or bowel disease, they may have blood in their stool, diarrhea, constipation, vomiting, or nausea.
  6. 6. Causes of Growth Retardation A family history of growth delays  Smaller birth and fetal weight  Low levels of GH  Low levels of thyroxine due to hypothyroidism  Turner syndrome, which is a genetic condition that affects females who are missing some or all of one X chromosome  Down syndrome, which is a genetic condition in which individuals have 47 chromosomes instead of the usual 46
  7. 7. Causes of Growth Retardation  Skeletal dysplasia, which is a group of conditions that cause problems with bone growth  Certain types of anemia, such as sickle cell anemia  Kidney, heart, digestive, or lung diseases  The use of certain drugs by their birth mother while she was pregnant  Poor nutrition  Severe stress
  8. 8. Detection Growth Retardation through Growth Chart A child is considered short if he or she has a height that is below the fifth percentile; alternatively, some define short stature as height less than 2 standard deviations below the mean, which is near the third percentile. Thus, 3-5% of all children are considered short. In order to maintain the same height percentile on the growth chart, growth velocity must be at least at the 25th percentile (see image).
  9. 9. Diagnosis of Growth Retardation Certain tests and imaging studies can also help their doctor develop a diagnosis.  A hand and wrist X-ray can provide important information about child’s bone development in relationship to their age.  Blood tests can pick up problems with hormone imbalances or help detect certain diseases of the: stomach, bowel, kidney & bone.
  10. 10. Treatment For Growth Retardation Depend on the cause of their delayed growth. For example, if child is diagnosed with a GH deficiency, their doctor may recommend giving them injections of GH at home. They may ask you to give them shots three times per week or as often as every day. This treatment will likely continue for several years as your child continues to grow.
  11. 11. Stunting Globally, one in four children under the age of five suffers from stunting. Stunting is the result of repeated insults to the growth plate, with reduced chondrocyte proliferation and maturation. A stunted child will have a lower height than her/ his peers and will resemble a younger child, usually 2–3 years younger.
  12. 12. Health consequences of stunting  Stunted growth caused by chronic malnutrition during the first 2 years of life had an adverse affect on a child’s cognitive ability later in childhood. In most cases the micronutrient status of stunted children has not been investigated, both because of the technical difficulties and because of the failure to identify stunting as an active condition of poor health.  For infants and young children, stunting is associated with a weaker immune system and higher risk of severe infectious diseases. When undernourished children become adults, they are more likely to suffer from high blood pressure, diabetes, heart disease, and obesity.  It is estimated that children under the age of five who are born to the shortest mothers (less than 145 centimeters) have a 40 percent increased risk of mortality.
  13. 13. Health consequences of stunting  Stunted women have higher maternal mortality rates and are more likely to have small and underweight babies—leading to a cycle of poor nutrition and poverty. A low birth weight child is more likely to be shorter during adulthood than one not born with a low birth weight.  A stunted child also has a higher risk of developing chronic diseases, impaired fat oxidation such as occurs in obesity, and reduced glucose tolerance. Stunted children were more likely to have problems oxidising fat and, as a result, stored more fat in their adipose tissues. The mechanisms behind this relation are unclear, but the researchers speculated that long-term undernutrition might have damaged the enzymes and hormones responsible for optimal lipid oxidation. Stunting can also lead to increased risk of hypertension.
  14. 14. Health consequences of stunting  A small adult has some functional limitations compared to a taller one, such as reduced working capacity. In societies where manpower is essential for subsistence this may have further consequences on the health and well-being not only of the individual, but also of his/her dependants . Stunted individuals often remain in a state of poverty throughout their lives, as they are not able to produce the extra income that might allow them to escape the cycle of mere subsistence.  Reproductive performance may also be affected by stature: a small woman will usually deliver a small child. The occurrence of IUGR is higher in stunted girls and this creates an inter-generational cycle of stunting (fig. 2.3).
  15. 15. Figure 2.3.The poor nutrition cycle.
  16. 16.  Several micronutrients are required for adequate growth among children.  The outcome typical of the stunting syndrome, i.e. retarded growth, developmental delays, poor cognitive function, lower IQ, weakened immune systems and greater risk of serious diseases like diabetes and cancer later in life, increased morbidity and mortality could be caused by poor status of such micronutrients.  However, it has been still unclear as to which nutrient deficiencies contribute most often to growth faltering in populations at risk for poor nutrition and poor growth. Impact of Micronutrient Deficiencies on Stunting Syndrome (Linear Growth)
  17. 17. Micronutrients Impact of Deficiencies Zinc observed to affect bone metabolism. poor zinc status would compromise immunity and neurological function. result in anorexia & also may contribute to growth retardation indirectly by reducing the intake of other growth limiting factors, such as energy and protein. Copper involved in growth through its role in cross-linking collagen fibers. deficiency would produce anaemia and affect development of cognitive function. Manganese deficiency is associated with skeletal abnormalities, including retarded growth. Vitamin D and calcium also affect bone development, as manifested through the condition known as rickets. Iron deficiency would produce anaemia, and affect development of cognitive function. result in anorexia & also may contribute to growth retardation indirectly by reducing the intake of other growth limiting factors, such as energy and protein.
  18. 18. Micronutrients Impact of Deficiencies Vitamin A Inadequate vitamin A status would also lead to increased susceptibility to infections. Magnesium result in anorexia & also may contribute to growth retardation indirectly by reducing the intake of other growth limiting factors, such as energy and protein. Others Children are very often recurrently infected by parasites or other pathogens that affect pathological action on skeletal metabolism. Helminth infections are known to cause malnutrition through the induction of anorexia, while infections of the gastrointestinal tract lead to chronic diarrhoea and nutrient malabsorption.
  19. 19. Classification of nutrients(according to their impact on growth)  Two types  For the type 1 nutrients, tissue levels are variable and deficiency is often associated with characteristic clinical signs and symptoms. When a type 1 deficiency occurs body stores are depleted, followed by a fall in tissue concentration. Metabolic pathways become compromised leading to clinical symptoms. However, growth is rarely affected. Type 2 nutrients are involved in essential physiological functions, tissue levels are fixed and there is no body store on which to draw upon.
  20. 20. Care practices Appropriate care practices include breastfeeding, complementary feeding, the use of health care and good hygiene practices. Education, knowledge, beliefs, workload and time availability, health and nutritional status of the caregivers, usually the mothers, are essential. In a study carried out in rural Chad, caregiver decisions on child feeding, actions taken when a child is ill, domestic workload and even caregiver’s level of satisfaction with life have shown to have an influence on children’s height-for-age.