I. Is your child’s height normal? To determine whether a child’s height is normal or not, the height is compared with the height of normal children of the same race, age and sex. If it is lower than the average height of healthy children of the same age and sex minus 2 standard deviations or below the third percentile, it is considered short. Generally speaking, if the growth rate is less than 7 cm/year in infants (under 3 years old), 4-5 cm/year in children (3 years old – puberty), and 5.5-6.5 cm/year in adolescence, then the growth is delayed. Children with short stature often have low self-esteem, which affects children’s physical and mental health and the scope of future employment, reducing the chances of success in their careers. Therefore, those with short stature should go to the hospital for further diagnosis and treatment in a timely manner. What are the factors that determine a child’s height? A child’s height is affected by many internal and external factors, so there are great individual differences. The intrinsic factors are mainly genetic. Using the following formula, the expected height of a child can be deduced from the parents’ height: boy height = (father’s height + mother’s height + 13)/2(±5cm), girl height = (father’s height + mother’s height – 13)/2(±5cm). Gender affects the child’s height, so when evaluating the growth and development of children, it is based on the standard for boys and girls respectively; the function of endocrine glands plays an important role in regulating the growth and development of children; lack of growth hormone, hypothyroidism, precocious puberty and early epiphyseal closure can all lead to short stature. External factors are mainly nutrition, adequate calories, high quality protein, various vitamins, minerals and essential trace elements are the material basis to ensure normal growth of children, the younger the child the greater the influence of nutrition, acute malnutrition mainly affects weight, long-term and chronic malnutrition can significantly affect the growth of height. Disease on the growth and development of interference is very obvious, such as chronic heart, lung, liver, kidney insufficiency, long-term chronic diseases, endocrine diseases can cause skeletal growth and neurological development delay; living environment plays an important role in children’s health. A good living environment (including: sufficient sunlight, fresh air, clean water, no noise, spacious housing, etc.) and healthy living habits, sufficient sleep, appropriate physical exercise and perfect health care are important factors to ensure that children’s growth and development to achieve the best condition. In short, to make children grow as long as possible, it is necessary to have balanced nutrition and to maintain a healthy lifestyle, i.e., adequate exercise and sleep, a happy mood, while taking care not to develop too early. What diseases can lead to short stature in children? There are many diseases that can lead to short stature in children, and the common causes are growth hormone deficiency, hypothyroidism, systemic diseases, chromosomal diseases, osteochondral dysplasia, and psychosocial growth disorders. The most common cause is idiopathic short stature, i.e., short stature without obvious disease. Children are often around the third percentile in height, with age-appropriate bone age and normal intellectual and sexual development. In children with physical puberty delay, growth retardation, delayed skeletal age and delayed puberty occur gradually after 1-2 years of age, with girls at 13 years of age and boys at 14 years of age not showing secondary sexual characteristics and with delayed skeletal age. The parents may have similar conditions, and some patients end up with normal height, but they are usually short. Turner syndrome, also known as congenital ovarian hypoplasia, is a female congenital genetic disorder, with significantly slower growth at the age of 2-3 years, dense hair, low hairline, thick and short neck, webbed neck, many dark pigmented nevi, sexual infancy, undeveloped uterus, chromosomal abnormalities, and low growth hormone levels in some patients. What should I do if I find that my child is short in stature? If a child is found to be short in stature, he/she should go to the pediatric endocrine clinic of a regular hospital in time. Usually, various routine examinations should be done to exclude systemic diseases, and some special examinations such as thyroid function, blood growth hormone level, blood chromosome examination, bone age check to understand bone development, and cranial examination to find out whether there are lesions in the brain. Most children with short stature can be treated effectively if they are seen in a timely manner. If you wait with the idea that “children grow late and leap at 23 years old”, you will miss the time of treatment (epiphysis will be closed by the time of consultation), and these children will be accompanied by “short” for the rest of their lives. V. Can children with short stature be treated? The answer is yes. For example, thyroid hormone supplementation is needed for thyroid hormone deficiency, and growth hormone treatment is available for growth hormone deficiency or unknown reasons. The premise of growth hormone application is that the epiphysis is not completely closed, and the earlier the age of starting treatment, the better, and the course of treatment can last until the epiphysis is closed; the younger the child is, the greater the child’s growth potential and space, the more sensitive the child is to treatment, and the better the growth effect. The younger the child is, the greater the growth potential and room for growth, the more sensitive the child is to treatment, and the better the growth effect. The treatment is a synthetic growth hormone replacement therapy, which is injected subcutaneously every night at bedtime. Therefore, early detection, early diagnosis, and early treatment are necessary for dwarfism. What is precocious puberty? Does precocious puberty affect the height of children? Precocious puberty is defined as the onset of puberty before the age of 8 for girls and 9 for boys. In recent years, the incidence of precocious puberty in children has been on the rise. It may be related to the following factors: ①Improvement of living standard: children are well nourished and their growth and development potential can be easily brought into full play. The role of cultural media: In many movies, TV, books and newspapers, there are many scenes and texts with sexual contents, which make children learn from them, and the nerve center in the brain that regulates puberty development starts early. ③ Too much taking some nutritional supplements: such as pollen, royal jelly, chicken embryo, silkworm pupae, etc. all contain hormone ingredients to varying degrees, children taking them is likely to lead to precocious sexual maturity. ④Other factors: parents’ genetic factors, taking sex hormone drugs, food additives, environmental pollution, etc. Some of them are caused by tumors in certain parts of the body, such as adrenal cortical tumors, germ cell tumors, brain tumors, etc. Children with precocious puberty have faster physical development than normal children of the same age and gender, and their body size also appears taller. However, due to the large amount of sex hormones, the epiphysis fusion is also promoted and the height growth stops early. As a result, the adult is shorter than normal. Therefore, if the child has precocious puberty, it is necessary to use drugs that inhibit sexual development and delay the healing of the epiphysis to prolong the growth of the child’s height as much as possible. Precocious puberty can cause psychological problems and corresponding social problems in children, and treatment is also needed to delay sexual development in order to achieve physical and mental health of children. VII. Pediatric obesity Pediatric obesity is defined as weight exceeding the average weight of healthy children of the same age plus 2 standard deviations or 20% of the average height standard weight of healthy children of the same sex. About 3-5% of obesity is caused by organic diseases, called secondary obesity or symptomatic obesity, mainly genetic diseases and endocrine diseases, such as cortisolism, hypothyroidism, obesity-reproductive incompetence, etc. About 95-97% of obesity is simple obesity, that is, due to caloric energy intake more than consumption, not accompanied by obvious endocrine and metabolic diseases. Mainly with more food, especially high fat, high sugar food, lack of exercise and genetic factors, parents are obese offspring obesity rate up to 70-80%; one of the two parents obese, offspring obesity incidence 40-50%. Obesity can cause hypertension, hyperlipidemia, hyperinsulinemia, type II diabetes, fatty liver, obesity – insufficient oxygen exchange syndrome, tibial inversion, hip inversion; also with adult cardiovascular disease, malignant tumor, gallstone disease, stroke has a correlation. Therefore, it is necessary to actively treat and prevent obesity. The principle of obesity treatment is to reduce caloric energy intake and increase caloric energy consumption, the main measures include diet therapy and exercise therapy. Low-fat, low-carbohydrate and high-protein recipes should be used, with vegetables, low-sugar fruits, wheat and rice as the main ingredients, plus lean meat, fish, eggs, skimmed milk and soy products, without sweets and fried foods. Proper exercise can increase caloric expenditure, promote fat decomposition, reduce insulin secretion, enhance protein synthesis, and promote muscle development. Low-intensity, low-impact, long-duration outdoor aerobic exercises, such as walking, jogging, climbing, badminton, and exercises, can be encouraged.