■ Short stature that really needs treatment is only a very low proportion of children who are really sick
■ Parents' anxiety about "not being tall enough" is an endogenous social anxiety, and what they need to treat is "heart disease"
■ Light incarnation of high anxiety, more pluralistic and tolerant judgment of the value of life, is to give the next generation a more precious gift to grow
"Rich and handsome", "big long legs", "aura of two meters eight"... If you praise people, it seems that you can always hook up with your height. Whether it's celebrity appearances, live streaming of Influencers, or personal selfies... If you want to beautify your image, it seems that you have to pull up your height again and again. In recent years, people's pursuit of "high altitude" has become more and more visible to the naked eye. In addition to making efforts to create a "prosperous" scene in terms of hearing and vision such as language and pictures, nowadays, from the doll, medical means are also more and more people pay attention, and more parents of children expect to help their children grow tall through sexual inhibition injections and growth hormone.
Height anxiety, can an injection solve it?
Obsessed and unwilling
Children around the age of 9, a kind of "sexual suppression injection", more than half a year, the cost of nearly 100,000 yuan; or joint injection of growth hormone for "doubles", a year will cost hundreds of thousands of yuan. Li Hui, director of the Growth and Development Research Office of the Capital Pediatric Research Institute, said that growth and development problems include overweight or obesity, thinness, malnutrition, abnormal height development, abnormal sexual development and abnormal intellectual development. "The height issue is just one aspect. However, in recent years, the proportion of parents who hope that their children's height will reach their expectations has increased significantly. ”
Xiao Wei, a 14-year-old boy accompanied by his parents, went to a well-known third-class hospital, and his appeal was to "get injections and grow tall". At that time, Xiao Wei's height was in the middle and lower reaches of the class, but it was already higher than his mother. "I'm less than 160 centimeters yet, and it's because I'm not tall that I want my children to be short." Xiao Wei's mother said. In this regard, Xiao Wei's father also agreed: "How can it be more than 170 centimeters?" ”
"In fact, many children have confirmed after examination and evaluation that their growth and development are normal, but parents are still not satisfied and hope to grow taller." Li Hui pointed out that according to mainland standards, adult males are less than 160 centimeters tall and females are defined as short figures.
But many parents have another standard in mind. Most of them want their child's height to be above the average height of the same age group. What's more, the parents themselves are not high, but they expect 180 cm for boys and 165 cm for girls.
Li Hui introduced that the normal value of children and adolescents' height ranges large. "If only above average is normal, then isn't half of the children below the standard?" She explains, "Height is largely determined by genetics. Of course, acquired nutrition, social and environmental factors will also have a certain impact. As long as the child's nutritional status is good and the growth potential is fully utilized, parents do not have to compare. ”
Li Hui said bluntly that the best way for children without medication indications is to develop good diet and living habits. Keep your mouth shut, open your legs, control your weight within the normal range, and ensure adequate sleep time, "as long as you do this, most of the problems can be solved."
In the interview, relevant experts specifically mentioned that the important factors affecting the height development of adolescents at present are overweight and obesity. Studies have shown that overweight and obesity in girls affect sexual development and lead to an earlier start of puberty. In general, precocious puberty can accelerate bone maturation in children, and the epiphysis heals prematurely, thus affecting their adult height.
"In the early years, boys were less precocious than girls. However, in recent years, it is also true that more and more overweight and obese boys have bone age and puberty in clinical practice. Li Hui said.
Needles, have you thought about it?
How does a child grow up? The experts interviewed said that this should start from the skeletal structure of the child. Take the thigh bone, or femur, for example, which is shaped like a long dumbbell, with two thick and rounded heads at both ends, and a slender middle. Among them, the round part of the two ends is the epiphysis, and the slender part in the middle is the backbone. At the junction of the epiphyseal and the backbone there is a layer of cartilaginous tissue called the epiphyseal plate. If you take an X-ray image, you will show a clear line, which is what doctors often call the "epiphyseal line". The cells of the epiphyseal plate of children continue to divide and proliferate, and the cells near the backbone continue to calcifilate into real bones, making the bones grow longer little by little, and the children grow taller. At a certain age, the epiphyseal plate is completely ossified, and the bone will stop growing. Therefore, in adult X-rays, the epiphyseal backbone will become integrated, and the epiphyseal line will no longer be found.
Sexual inhibition injection is to inhibit the child's development through long-term drug intervention, so that the rapid growth of height is slowed down, so as to win more time for the body. According to industry insiders, this type of drug has been used in clinical practice for more than 20 years.
Currently, growth hormone drugs that are often "partnered" with sexual suppression needles have a longer application time. Growth hormone is a protein secreted in the anterior lobe of the human pituitary gland, which can promote the growth and development of bones, muscles and organs, and stimulate bone cell metabolism, osteoarticular cartilage, epiphyseal cartilage growth, thereby promoting height growth. Growth hormone drugs are obtained by recombinant DNA technology, through subcutaneous injection into the human body to supplement growth hormone, common indications in pediatrics are growth hormone deficiency, small-for-gestational age, idiopathic short stature and so on.
The experts interviewed said that in clinical diagnosis and treatment, there are many complex factors that need to be paid attention to and considered around injection or non-injection. First of all, it is necessary to determine whether the child really meets the above indications, including whether it is really in line with the diagnosis of short stature, whether it is really caused by lack of growth hormone, precocious puberty, and also combined with family height history. Around these indications, doctors should use a variety of tools, monitoring methods, and detection techniques to make a comprehensive and comprehensive judgment on children. For example, the child's growth and development reference curve is used to judge the child's development, the growth hormone stimulation test is used to check the child's growth hormone level, the epiphyseal plate is x-rayed to estimate the child's bone age, and the genetic dwarfism is excluded... In addition, children with diabetes, critically ill patients with metaphyseal closure, serious systemic infections, active tumors or active head injuries, pregnant and lactating women are not suitable for the use of growth hormone.
After some parents are persuaded to leave some hospitals because their children have no treatment indications, they will also go to other hospitals through various channels to find a way, and even seek home remedies. For such parents, the experts interviewed said that those who do not meet the drug indications after being diagnosed by the doctor should not listen to small advertisements, small remedies just to make the child taller, or take the child to an irregular medical institution to inject hormones, so as not to cause health damage and economic loss.
Experts also stressed that sex suppressor needles and growth hormone drugs are not "miracle drugs" for growing tall, and the height benefits obtained through them are limited and cannot exceed the upper limit of genetic height. "In general, the benefit of long-term medication in children with idiopathic short stature is 3 to 7 centimeters." Li Hui introduced that this is an average value, whether it can be increased, how much can be increased, but also depends on many factors. In clinical practice, it is common for parents to be motivated by some "typical cases" such as children who are said to grow 20 or 30 centimeters tall after injections, "but how many of them are the credit of injections?" Parents should make rational judgments, and doctors should also do a good job of informing."
"Objectively speaking, whether it is a sex suppression needle or growth hormone, it seems that the safety is relatively high, and the common adverse events are also mild." Li Hui pointed out that this does not mean that there is no risk and must be used with caution under the scientific assessment of a doctor.
The results of the monitoring of safety data from more than 500,000 patients worldwide show that the overall incidence of adverse reactions to HGH treatment is less than 3%. With the increasing application of the above drugs in pediatric clinics, the research on their application indications, dosage, efficacy and safety is also gradually deepening.
For doctors, the main reference - bone age examination still has high technical content, reference standards are not uniform, personalized assessment is easy to have a certain error and other factors, growth hormone stimulation test itself is not perfect, sometimes there will be a certain error, so do not rush to the program, conclusions. "In particular, the individualized characteristics of adolescent development in adolescents are prominent, there is no unified law of dynamic changes, there is a lot of uncertainty, and doctors should be more patient and spend more time observing and evaluating." Li Hui said that this is particularly important.
Li Hui suggested that relevant parents must go to professional medical institutions for treatment, find more doctors for consultation, listen to opinions, and think rationally. If you really need to take the drug, you must inject under the guidance of an experienced specialist, the specific dosage should be determined according to the patient's condition, and you should follow the doctor's instructions to go to the hospital regularly for follow-up consultations and measure the relevant indicators.
Adolescent "panic disorder"
"Adolescence, what a beautiful word, how did it get to some parents and become terrible?" Li Hui said incomprehensibly, "Many children have not really started even puberty, and the bone age is not much different from the actual age, in order to make the child grow taller, parents require direct injections." This is completely wrong! There are also many parents who take their own experience to say things, find that their children's sexual development is earlier than their own adolescence, and they think that their children are precocious, and this kind of empiricism must not be tolerated. ”
It is understood that pubertal development is mainly assessed by sudden increase in height, sexual development, and menarche. European and American data show that in the more than 100 years from 1840 to 1960, the age of menarche dropped from 16 years to 13.5 years, with an average of 4 months in advance every 10 years, and then stabilized at about 13 years old.
Such a situation is no exception on the mainland. Studies have shown that the average age of menarche in Beijing was 14.2 years old in 1962, 12.06 years old in 2010, and 2.14 years earlier in 48 years, with an average of 5 months in advance every 10 years. In recent years, survey data in some parts of the country have also shown a clear trend of adolescence development. For example, the proportion of breast development in girls aged 6 to 7 in Guangzhou, Guangdong Province, reached 15%, and the proportion of breast development in girls in Shanghai before the age of 8 was 17.2%. These survey data suggest that the early development of puberty is a common phenomenon in the long-term growth trend of children in mainland China. In the past 40 years, children on the mainland have seen a significant advance in the process of pubertal development.
The study also found that advanced pubertal development does not mean a decrease in height, especially in adult height. "Therefore, the growth evaluation of individual children should be fully aware of the existence of the early trend of pubertal development, and a comprehensive evaluation should be carried out in combination with height, growth rate, degree of sexual development, bone age and genetic height, and follow-up observation to make a scientific assessment to prevent excessive diagnosis and over-treatment of precocious puberty." Li Hui stressed.
In Li Hui's view, adolescent children need more good care, and parents should not only pay attention to their children's physical development, but also care for their children's hearts. On the one hand, short stature can lead to psychological disorders in children, affecting children's normal learning and social activities. But on the other hand, excessive transmission of height anxiety may also bring psychological stress to children. A study by researchers at Indiana University in the United States found that short children who received growth hormone therapy may be more likely to be depressed and withdrawn than their peers who were similar in height and did not receive treatment. Researchers believe that daily hormone injections, frequent outpatient treatment, and repeated discussions about height issues may affect the child's mental health.
Some interviewed doctors mentioned that they had received an adolescent child, whose weight and height were within the normal range, but the parents were not satisfied, so they had to let the doctor check this and that, "find a way to cure, help the child jump up and down." "In fact, it seems that everything is normal for the child, but the parents have to check." After checking it out, as I expected, I was persuaded to go back. The doctor helplessly recalled that the matter did not end because of this, and after that, the parents went to many hospitals for examination, "Finally came to me again, still want to get injections."
"I was looking at the child, and I was in a particularly bad mood, his eyes were dark, and his face was full of grievances, as if he had done something wrong. After a good explanation to his father, I left the child alone for a while. I said, boy, you are very good, there is no problem. Feel free to go to school! The next time your dad wants to take you to the doctor for this matter, you say that the school can't take a leave of absence. The doctor clearly remembered that after hearing these words, the child's eyes became radiant, and the whole little face lit up.
"Real hammer" from many parties
Seeing more and more children who use height as the reason for medical treatment, many problems have surfaced. Is the height problem of children and adolescents in the mainland today very prominent? Is the incidence of short stature on the mainland increasing year by year? Is it that as much as nearly 50% of children and adolescents do not grow in height to reach genetic height? To this end, Li Hui tried to give a "real hammer" with a large sample of continuous national survey data.
After combing through the survey data of the "Survey of Children's Physical Development in Nine Cities of China" (1975-2015) and the "Survey on the Physical Fitness and Health of Chinese Students" (1985-2014), Li Hui found that the average height of 18-year-olds (near-adult height) in the 40 years from 1975 to 2015 increased from 167.4 cm in 1975 to 172.7 cm in 2014, and from 157.0 cm to 160.5 cm for girls.
In a study from the School of Public Health of Peking University and the Institute of Child and Adolescent Health of Peking University, the height data of 18-year-old Han adolescents in six national student physical fitness and health surveys in 1985, 1995, 2000, 2005 124099, 2010 and 2014 also found that from 1985 to 2014, the average height of 18-year-old male adolescents in mainland China increased at a rate of 1.3 cm/10 years, and the growth rate of female adolescents was 0.8 cm/10 years.
A global study published in the International Medical Journal The Lancet from a team at Imperial College London also showed that Chinese are getting higher and higher. In the 35 years from 1985 to 2019, the average height of Chinese men increased by nearly 9 centimeters, ranking first among nearly 200 countries and regions, and the third in height growth of women. At present, the average height of 19-year-old men and women in China even exceeds that of countries such as Portugal, Italy and Spain in southern Europe, ranking first in East Asia.
At the same time as they grow taller, the rate of stunting among children and adolescents on the mainland is also gradually decreasing. The researchers applied World Health Organization criteria to assess the height of children under 7 years of age in nine cities on the mainland. The results showed that in the 30 years from 1985 to 2015, the rate of stunting among children in urban areas decreased from 5.92% to 0.75%, and in rural suburban areas from 19.02% to 1.18%.
"These changes fully show that the height of children in mainland China has improved and improved significantly since the reform and opening up, and the incidence of growth retardation/short stature in the population has decreased rapidly, not more and more." Li Hui pointed out that this means that only a very small proportion of children who really need medical treatment are indeed sick. Parents' various "inner volume" behaviors around the height of their children, as well as some children and adolescents' own pursuit of tall figure and anxiety about not being tall enough, may be rooted in more of an endogenous social anxiety.
In this regard, many interviewed experts said that what really needs treatment is not only height, but also "heart disease". "The definition of a better future should be richer, the definition of personal excellence and success should be more imaginative, and the judgment of the value of life should be more diverse and tolerant." One interviewed expert said, "Passing on these ideas to children, everyone consciously changing a single aesthetic from their own beginnings, and lightening high anxiety is to give the next generation more precious gifts and care." ”
In the interview, Li Hui specifically mentioned that although the height development level of mainland children and adolescents has increased significantly in the past 40 years, it has entered a period of slow growth from a period of rapid growth in the past 10 years. Because the height growth dividend brought about by the improvement of living environment and nutritional status has gradually been exerted. This also suggests that the historical experience of the current parents' generation is much higher than the grandparents' generation, and it may be difficult to replicate in the next generation. What parents can do in the new era is to systematically understand the characteristics of children's growth and development, respect science, do not believe hearsay, and do not blindly follow the trend because of fragmented information. At the same time, continue to pay attention to and monitor the growth and development of children, help children develop healthy and reasonable living habits, and truly achieve comprehensive care and moderate care. (Reporter Cui Fang)
Source: Health Newspaper