Experts said that although the advance and backwardness of bone age may affect the final height of children, it is inaccurate and unscientific to judge adult height based on only one bone age result. A bone age prediction can only reflect the bone maturity of the child at that time, and the growth and development of children is a linear dynamic process, with many influencing factors, so it must be combined with the child's development level, hormone status, nutritional status by a professional pediatric endocrinologist comprehensive assessment, dynamic monitoring.
Spring is the golden period for children to grow taller. In the past spring, many children have sprung up like mushrooms, while some children have not seen a jump, so many parents are struggling with whether to take their children to measure their bone age.
The importance of bone age is also widely debated among parents. Some parents think that bone age is useless, and children's height is natural; Some parents believe that by managing weight, eating less supplements and foods with short growth cycles, and using drugs to inhibit bone age, children can grow taller.
So what role does bone age play in children's growth and development? Does inhibiting bone age really make children grow taller?
Bone age measurement is evaluated by scientific calculations
Bone age, that is, the age of bones, is used to determine the size, shape, structure and relationship between specific parts of bones to understand the degree of maturity of bones. Bone age is an important indicator to reflect children's physical development and determine children's developmental stage.
Measuring bone age is not complicated, just a left-hand wrist X-ray is required.
After taking bone age films, doctors will generally evaluate them according to simple counting methods, atlas methods, scoring methods, or computerized bone age scoring systems.
"Counting is the measurement of bone age by counting the number of ossification centers in the wrist." Zheng Rongxiu, chief physician of pediatrics of Tianjin Medical University General Hospital, introduced that this method is only suitable for children aged 3-7 years old, and the error is large, and this method cannot be used alone for evaluation.
At present, the main internationally used bone age evaluation methods are G-P atlas and TW3 scoring method.
The atlas method is to compare the wrist X-ray of the subject with the standard X-ray of the wrist (the standard map represents the average level of children of that age), and the bone age of the most similar standard film is used as the bone age of the subject. Since the earliest application and the most widely used is the "wrist bone development X-ray Atlas" designed and published by the Americans Greulich and Pyle in 1950, this method is also referred to as G-P atlas method.
The G-P atlas method has become the most widely used bone age assessment method in the world due to its simplicity and speed, but the atlas used is based on a sample of white European children.
"Due to racial differences and socio-economic environmental factors, the G-P mapping method cannot be applied to all groups of people, and needs to be updated at any time as society develops." Zheng Rongxiu pointed out that the subjective factors of the G-P atlas method are obvious, which can easily lead to the consistency and accuracy of interpretation.
In terms of scoring method to assess bone age, the TW series scoring method is widely used, which is based on children in Europe and North America, and the TW3 method is mainly used. "Although the TW3 method is accurate, the process is complicated, and it takes a long time to interpret a bone age X-ray, which is not suitable for the fast-paced work of mainland outpatient clinics." Zheng Rongxiu said.
At present, the scoring bone age assessment methods formulated with mainland children as the reference standard are CHN method and China 05 method. In the 80s of the 20th century, according to the large sample of mainland children, the mainland formulated the CHN method of bone age standard, which is simple and fast to evaluate, and has been widely used in many cities in the mainland. The China 05 method has formulated bone age standards suitable for contemporary children and adolescents in mainland China, which is relatively accurate, especially suitable for the determination of bone age of children with abnormal bone age pieces such as short stature and precocious puberty, but the disadvantage is that the method is cumbersome, complex and time-consuming. The computer automatic bone age assessment system can solve this problem to some extent.
The child's growth potential, bone age has the final say
"Usually, bone age coincides with age, and the difference between the two is not more than one year." Li Yapu, attending physician of pediatrics at the General Hospital of Tianjin Medical University, said, but in the process of growth and development, some children's bone age will advance or lag behind.
There are many factors that affect the change of bone age, first of all, genetic factors, such as different groups of people have different bone age and physical development speed; In addition, a scientific lifestyle, such as a balanced nutritional status, moderate exercise, and adequate sleep, contributes to the normal growth of bone age.
"As doctors, we are more concerned about whether the child has diseases that affect bone development." Zheng Rongxiu gives examples, such as diseases such as premature bone age, adrenal hyperplasia or tumors, ovarian granulosis cell tumors, hyperthyroidism, simple obesity with excessive body growth; Diseases of bone age delay include growth hormone deficiency, Turner syndrome, hypothyroidism, and achondroplasia.
Zheng Rongxiu explained that vitamin D and vitamin A play an important role in bone metabolism, which can maintain the normal growth and reconstruction of bones, and the lack of vitamin D and vitamin A can lead to bone development retardation; Growth hormone and thyroid hormone can promote the growth and maturation of epiphyseal cartilage, sex hormones can enhance the activity of osteoblasts and participate in bone growth and maturation, while glucocorticoids have an inhibitory effect on bone formation; Some bioactive substances such as bone morphogenetic protein, osteocalcin, insulin-like growth factor, etc. have the effect of promoting bone formation, while interferon-γ, interleukin-4, carbon monoxide inhibit bone resorption.
In general, early bone age suggests impaired growth potential, which may affect final adult height. However, if the bone age is backward, in the absence of formal treatment, the child's growth motivation is insufficient, which will also affect the future height.
"Although the advance and backwardness of bone age may affect a child's final height, it is inaccurate and unscientific to determine adult height based on only one bone age result." Zheng Rongxiu explained that a bone age prediction can only reflect the bone maturity of the child at that time, and the growth and development of children is a linear dynamic process, with many influencing factors, so it must be combined with the child's development level, hormone status, and nutritional status to be comprehensively evaluated and dynamically monitored by a professional pediatric endocrinologist.
In addition, because bone age prediction of adult height is based on normal growth and development, the prediction is less accurate for children with disease conditions such as growth hormone deficiency and precocious puberty.
Bone age is not always better
Some parents feel that bone age in advance indicates impaired growth potential, so bone age lagging behind age should indicate high growth potential. Therefore, they hope to suppress bone age by eating less foods with short growth cycles, using drugs, and giving bone age suppression injections, so that it lags behind the actual age of children.
"The difference between bone age and age should be within a reasonable range, which is generally 1 year, and the growth rate of the two should be consistent." Zheng Rongxiu said that if it exceeds this range, or the bone age growth rate is getting lagging behind the age, there is a high probability that there is a disease. Therefore, the younger the bone age, the better.
"And the bone age that has grown cannot be inhibited back, and the drug can only delay the subsequent progress of bone age." Li Yapu reminded that drugs that inhibit bone age should not be used or not, and must be evaluated by professional child growth and development doctors. Like children with central precocious puberty, the use of sexual development suppression needles can indeed delay bone age development. However, children need to be closely monitored during use, and parents must not blindly follow the trend.
"The best growth state for children is to grow reasonably with the growth and development of bone age, which requires joint efforts from three aspects: healthy diet, proper exercise, and adequate sleep." Zheng Rongxiu suggested.
In terms of healthy diet, we should usually pay attention to a balanced diet, achieve a balanced nutrition, no need to add additional supplements, and bone age growth has little to do with the length of the growth cycle of the food eaten, as long as it is a healthy food obtained through formal channels. In addition, you can eat more foods rich in vitamin D, bask in the sun more, promote vitamin D synthesis, and promote calcium absorption.
Children should usually pay attention to weight management, before the epiphysis is closed, more exercises such as high jumping and skipping rope can stimulate bone development, promote linear bone growth, and increase height.
Getting enough sleep is very important for children's growth and development. Growth hormone is secreted mainly during the nocturnal deep sleep phase, especially between 10 p.m. and 1 a.m. Therefore, getting enough sleep can help bone growth.
"Children's growth and development is a dynamic development process, and dynamic monitoring of changes in height and bone age, and evaluation of growth and development are important steps to maintain children's health." Zheng Rongxiu suggested that parents can take their children to the pediatric growth and development clinic of a regular hospital every six months or one year for growth and development consultation, assessment and follow-up. (Reporter Chen Xi)
Source: Science and Technology Daily