What Is Normal Growth? Principles, Practicalities and Pitfalls of Growth Assessments in Infants and Children.

IF 3.2 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM Annals of Nutrition and Metabolism Pub Date : 2024-11-27 DOI:10.1159/000541226
Tanis R Fenton, Nicole Gilbert, Seham Elmrayed, Carol J Fenton, Dana L Boctor
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Abstract

Background: Growth assessments are a pillar of public health surveillance, individual health screening, and clinical care. Normal growth is defined differently for individuals versus populations. The World Health Organization (WHO) growth standards were developed to describe the pattern of growth in healthy children without socioeconomic limitations whose mothers planned to breastfeed. The growth standards' cut-off points of ±2 standard deviations (z-scores) were defined for population assessments, based on attained size, to describe stunting and wasting at the lower end and overweight at the higher end. In a healthy population, one would expect 2.3% of the population to be above and below these cut-points. Higher child mortality rates associated with higher rates of stunting and wasting noted in observational studies validated these WHO cut-offs. There are knowledge gaps influencing the accuracy and effectiveness of growth assessments in individual children, posing challenges for health care providers.

Summary: The principles of assessing normal growth in children and preterm infants are reviewed, along with pitfalls to be avoided. Growth is determined by genetics and modified by the interplay with nutritional, environmental, socioeconomic, and possibly intergenerational factors. This complexity is reflected at both the population and individual level. However, normal growth in an individual has unique-specific factors so requires a comprehensive assessment. Normal growth for an individual child could be defined as the progression of changes in anthropometric measurements to achieve the individual's genetic potential. A misdiagnosis of growth faltering can occur if infants and children are asses with one-time rather than serial measures, and if age is not corrected for prematurity. Health care provider sensitivity and cognizance when communicating about a child's size is important for parental reassurance and avoiding stigma and unnecessary pressures or restrictions around feeding.

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什么是正常生长?婴儿和儿童生长评估的原则、实用性和误区》。
背景:生长评估是公共卫生监测、个人健康检查和临床护理的支柱。个人与人群对正常生长的定义不同。世界卫生组织(WHO)制定了生长标准,以描述母亲计划母乳喂养的无社会经济条件限制的健康儿童的生长模式。生长标准的分界点为±2 个标准差(z-分数),用于人口评估,以达到的体型为基础,低者描述发育迟缓和消瘦,高者描述超重。在健康人口中,预计有 2.3% 的人口高于或低于这些临界点。观察性研究中发现,儿童死亡率较高与发育迟缓和消瘦率较高相关联,这验证了世卫组织的这些临界值。总结:本文回顾了评估儿童和早产儿正常生长的原则,以及应避免的误区。生长由遗传决定,并受营养、环境、社会经济以及可能的代际因素的影响。这种复杂性既体现在群体层面,也体现在个体层面。然而,个体的正常生长具有独特的特定因素,因此需要进行全面评估。儿童个体的正常生长可定义为人体测量值的逐步变化,以实现个体的遗传潜能。如果对婴儿和儿童的评估是一次性的,而不是连续性的,也没有对早产儿的年龄进行校正,那么就可能出现生长迟缓的误诊。医护人员在与家长沟通孩子的体型时,要保持敏感性和认知度,这对家长放心、避免羞辱和不必要的喂养压力或限制非常重要。
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来源期刊
Annals of Nutrition and Metabolism
Annals of Nutrition and Metabolism 医学-内分泌学与代谢
CiteScore
6.50
自引率
0.00%
发文量
55
审稿时长
6-12 weeks
期刊介绍: ''Annals of Nutrition and Metabolism'' is a leading international peer-reviewed journal for sharing information on human nutrition, metabolism and related fields, covering the broad and multidisciplinary nature of science in nutrition and metabolism. As the official journal of both the International Union of Nutritional Sciences (IUNS) and the Federation of European Nutrition Societies (FENS), the journal has a high visibility among both researchers and users of research outputs, including policy makers, across Europe and around the world.
期刊最新文献
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