Unreasonable dietary structure, poor eating behaviors or improper parental feeding in children and adolescents can lead to the occurrence and development of growth retardation in children and adolescents. How to keep children away from stunting? Listen to what the pharmacist has to say.
Height standards for children and adolescents
The development of children has always been a concern for parents, especially height, when they see some friends around them grow very tall, parents are worried, worried about how their children do not grow.
In fact, there is a reference standard for the height of each age, and you can't blindly pay attention to some of the "big and tall", compare the standards to see which level your child is at~
Table Percentile values for length/height for age for boys under 7 years of age
Unit: cm
| age | P3 | P10 | P25 | P50 | P75 | P90 | P97 |
| 0 years old | 47.6 | 48.7 | 49.9 | 51.2 | 52.5 | 53.6 | 54.8 |
| 1 year old | 71.7 | 73.3 | 74.9 | 76.7 | 78.5 | 80.1 | 81.6 |
| 2 years old | 82.4 | 84.2 | 86.1 | 88.2 | 90.3 | 92.2 | 94.0 |
| 3 years old | 90.9 | 93.0 | 95.1 | 97.5 | 99.9 | 102.0 | 104.1 |
| 4 years old | 97.6 | 99.9 | 102.3 | 104.9 | 107.5 | 109.8 | 112.2 |
| 5 years old | 104.1 | 106.6 | 109.1 | 112.0 | 114.8 | 117.4 | 119.9 |
| 6 years old | 110.3 | 113.0 | 115.7 | 118.8 | 121.9 | 124.6 | 127.3 |
Table Percentile values for length/height for age for girls under 7 years of age
Unit: cm
| age | P3 | P10 | P25 | P50 | P75 | P90 | P97 |
| 0 years old | 46.8 | 47.9 | 49.1 | 50.3 | 51.6 | 52.7 | 53.8 |
| 1 year old | 70.4 | 71.9 | 73.5 | 75.2 | 77.0 | 78.6 | 80.1 |
| 2 years old | 81.2 | 83.0 | 84.9 | 87.0 | 89.1 | 90.9 | 92.8 |
| 3 years old | 89.7 | 91.8 | 93.9 | 96.2 | 98.5 | 100.7 | 102.7 |
| 4 years old | 96.5 | 98.8 | 101.1 | 103.7 | 106.3 | 108.6 | 110.9 |
| 5 years old | 103.0 | 105.5 | 108.0 | 110.8 | 113.6 | 116.1 | 118.6 |
| 6 years old | 109.0 | 111.7 | 114.5 | 117.5 | 120.6 | 123.3 | 126.0 |
The height growth level is divided into 5 grades: height <P3 is inferior; Height ≥ P3 and < P25 is lower middle; Height ≥ P25 and < P75 is moderate; Height ≥ P75 and < P97 is upper-middle; Height≥P97 is superior.
Citation: "Growth Standards for Children Under 7 Years of Age" (WS/T 423)
Table Criteria for Grading Height Development of Boys
Unit: cm
| age | -2SD | -1SD | median | +1SD | +2SD |
| 7 years old | 113.51 | 119.49 | 125.48 | 131.47 | 137.46 |
| 8 years old | 118.35 | 124.53 | 130.72 | 136.90 | 143.08 |
| 9 years old | 122.74 | 129.27 | 135.81 | 142.35 | 148.88 |
| 10 years old | 126.79 | 133.77 | 140.76 | 147.75 | 154.74 |
| 11 years old | 130.39 | 138.20 | 146.01 | 153.82 | 161.54 |
| 12 years old | 134.48 | 143.33 | 152.18 | 161.03 | 169.89 |
| 13 years old | 143.01 | 151.60 | 160.19 | 168.78 | 177.38 |
| 14 years old | 150.22 | 157.93 | 165.63 | 173.34 | 181.05 |
| 15 years old | 155.25 | 162.14 | 169.02 | 175.91 | 182.79 |
| 16 years old | 157.72 | 164.15 | 170.58 | 177.01 | 183.44 |
| 17 years old | 158.76 | 165.07 | 171.39 | 177.70 | 184.01 |
| 18 years old | 158.81 | 165.12 | 171.42 | 177.73 | 184.03 |
Table Criteria for Dividing Girls' Height Development Grades
Unit: cm
| age | -2SD | -1SD | median | +1SD | +2SD |
| 7 years old | 112.29 | 118.21 | 124.13 | 130.05 | 135.97 |
| 8 years old | 116.83 | 123.09 | 129.34 | 135.59 | 141.84 |
| 9 years old | 121.31 | 128.11 | 134.91 | 141.71 | 148.51 |
| 10 years old | 126.38 | 133.78 | 141.18 | 148.57 | 155.97 |
| 11 years old | 132.09 | 139.72 | 147.36 | 154.99 | 162.63 |
| 12 years old | 138.11 | 145.26 | 152.41 | 159.56 | 166.71 |
| 13 years old | 143.75 | 149.91 | 156.07 | 162.23 | 168.39 |
| 14 years old | 146.18 | 151.98 | 157.78 | 163.58 | 169.38 |
| 15 years old | 147.02 | 152.74 | 158.47 | 164.19 | 169.91 |
| 16 years old | 147.59 | 153.26 | 158.93 | 164.60 | 170.27 |
| 17 years old | 147.82 | 153.50 | 159.18 | 164.86 | 170.54 |
| 18 years old | 148.54 | 154.28 | 160.01 | 165.74 | 171.48 |
The height development level is divided into 5 levels: height <-2SD is inferior; Height ≥-2SD and <-1SD is lower to middle; Height ≥-1SD and ≤+1SD is moderate; Height >+1SD and ≤+2SD are upper-middle; Height >+2SD is superior.
Citation: "Evaluation of Height Development Grades of Children and Adolescents Aged 7~18" (WS/T 612)
How can you tell if a child has short stature?
Short stature is defined as a child whose height is less than 2 standard deviations (-2SD) of the average height of children of the same sex, age, and race, and the growth rate is less than 5 cm per year. The following conditions suggest slow growth:
(1) The growth rate of children is less than 7 cm/year before the age of 3;
(2) 3 years old to puberty, less than 5 cm/year;
(3) Puberty is less than 6 cm/year.
There are many causes of failure to thrive, including normal growth variability (familial short stature, constitutional growth retardation, idiopathic short stature, small-for-gestational-age infants) and pathological short stature (malnutrition, growth hormone deficiency, glucocorticoid therapy, gastrointestinal disorders, precocious puberty, inherited metabolic disorders, etc.).
According to the Report on the Status of Nutrition and Chronic Diseases in China (2020), the growth retardation rate of children under 6 years old is 4.8%, and the growth retardation rate of children and adolescents aged 6~17 years is 1.7%. Growth retardation affects the physical and intellectual development of children and adolescents, resulting in physical decline, poor academic performance, etc., and in severe cases, it is easy to suffer from diarrhea, pneumonia and other diseases.
Growth retardation in children and adolescents
Dietary principles and recommendations
01 Eat a variety of foods to meet the needs of growth and development
To achieve a variety of foods, each meal should include cereals and potatoes, vegetables and fruits, livestock, poultry, fish and eggs, milk and soybeans and other food categories of 3 or more; There are more than 12 types of food per day and more than 25 types per week.
Children aged 2~5 years old should have 3 meals and 2 additional meals a day; Choose foods or snacks with high nutrient density, such as milk, fruits, eggs and nuts, with a small amount of fluffy pasta; Drink 350~500ml of milk and 600~800ml of water every day. Children and adolescents aged 6~17 years old should arrange three meals reasonably and eat breakfast; More than 300ml of liquid milk or an equivalent amount of dairy products should be consumed every day.
02 Eat and nourish according to people, places and times, and regulate the spleen and stomach
Children and adolescents should follow the principle of timely maintenance of yang in spring and summer, and yin in autumn and winter. In spring, when the cold gradually recedes and yang qi grows, it should be appropriate to ingest pungent and warm things to help the growth of yang qi, such as onions, garlic, leeks, etc.
In summer, the yang energy is more external and the body is deficient, so you should eat less raw and cold. In autumn, when it is dry, you should choose foods that are sweet and nourishing to nourish the lungs, such as pear and white fungus.
The winter is cold, in addition to the warmth, should not forget to nourish the yin, can eat duck meat, pork, etc. appropriately.
03Cook properly and develop healthy eating behaviors
The food provided for children and adolescents should be fresh and hygienic, and it is advisable to choose foods that are peaceful, easy to digest, and spleen-strengthening and appetizing. Reasonable cooking, it is advisable to use steaming, boiling, stewing, simmering and other cooking methods, and less frying, grilling, pickling, etc.
Children and adolescents should not be picky eaters, not hungry and impermanent, choose snacks reasonably, drink enough water, and do not drink sugary drinks.
Avoid cold, greasy, hard and unclean foods, and eat less foods high in salt, sugar, fat and trans fatty acids.
04Nutrition education and the creation of a healthy food environment
Through a variety of communication channels, the knowledge and skills of nutrition and health and traditional food nutrition will be imparted to children and adolescents and their parents, including the causes of growth retardation, intervention methods, adverse effects, etc., so as to gradually improve the nutritional literacy of children, adolescents and parents.
05Maintain appropriate physical activity and focus on sleep and mental health
It is recommended that children and adolescents with growth retardation should promote their growth and development through moderate-intensity physical activities (such as rope skipping, basketball, swimming, etc.), combined with traditional fitness methods (such as Baduanjin, Wufowl Opera, martial arts, etc.).
It is recommended that children aged 2~5 years old should have a total of 3 hours of physical activity per day, at least 2 hours of outdoor activity per day, and no less than 1 hour of moderate and above intensity physical activity.
Children and adolescents aged 6~17 years old should carry out no less than 1 hour of moderate and high-intensity physical activity every day, and for children and adolescents with growth retardation, there should be 3 days a week to strengthen muscle strength and/or bone health exercise (such as tug-of-war, long jump, etc.).
Children aged 2~5 years old should sleep for 10~13 hours a day, including 1~2 hours of nap time; Children aged 6~12 should sleep for 9~12 hours a day, and children and adolescents aged 13~17 should sleep for 8~10 hours.
Pay attention to the emotional and behavioral management of children and adolescents, guide them to correctly understand body shape, maintain a healthy weight, and promote physical and mental health development.
06Regularly monitor physical development, strengthen dietary assessment and guidance
Regularly monitor the physical development of children and adolescents, evaluate their growth status according to their growth rate or deviation from the growth curve, and adjust the guidance plan in a timely manner.
TCM syndrome types and dietary and pharmacological recommendations for growth retardation
Traditional Chinese medicine believes that children have "spleen insufficiency", spleen and stomach function is complete but not strong, due to improper feeding, eating disorders, loss of appetite, anorexia, dietary stagnation, picky eating, partial eating, dieting and other problems, it is easy to have abnormalities in acceptance, decay, subtle metaplasia and transfusion. The spleen and stomach are the foundation of nurture, the source of qi and blood biochemistry, and provide a guarantee for the growth and development of children and adolescents; The function of the main bone of the kidney is directly related to the growth and development of children and adolescents.
Table Dietary and pharmacological recommendations for different syndrome types of growth retardation
| TCM syndrome type | Clinical presentation | Edible and medicinal substances |
| Spleen and stomach qi deficiency syndrome | Fatigue, loss of appetite, easy abdominal distension after eating, dizziness, drowsiness, lack of energy, yellowish complexion, pale tongue, pale tongue, weak pulse. | Poria cocos, yam, lotus seeds, seeds, coix seeds, jujubes, white lentils |
| Spleen deficiency and lung weakness | Pale complexion, lukewarm hands and feet, lack of food, unformed stools, shortness of breath, easy sweating, easy to catch colds, pale tongue, white tongue, weak pulse. | Yam, jujube, ginger, yellow essence |
| Spleen deficiency and dampness syndrome | Lack of food, stomach fullness and discomfort, unformed stool, sticky mouth, heaviness of the body, lazy speech and little movement, pale red tongue, thick tongue coating, and wet pulse. | Coix seeds, orange peel, poria cocos, white lentils |
| Spleen and stomach deficiency and cold syndrome | The stomach often feels cold and painful, which is more obvious after eating cold things, abdominal distention, vomiting, lack of food, unformed stool, or frequent diarrhea, fatigue, easy to appear body emaciation, pale tongue, and slow pulse. | Dried ginger, cloves, cumin, peppercorns |
| Spleen and stomach yin deficiency syndrome | Dry lips and mouth, easy to thirst, no taste in the mouth, poor appetite, gradually reduced food intake, dry stool is not easy to discharge, red tongue, little tongue coating, or no tongue coating, thin pulses. | Lily, yam, yellow essence |
| Kidney Yang deficiency syndrome | Thin and small, cold, afraid of cold, cold hands and feet, frequent urination at night, easy to lack of energy during the day, cold back, loose stools or frequent diarrhea, pale tongue, thin white tongue, slow and weak pulse. | Puzzle kernel, sword bean |
| Kidney yin deficiency syndrome | Thin and small, easy to fatigue and weakness, tinnitus, easy to dry mouth and tongue, dry throat, hot hands and feet, hot flashes in the afternoon, red tongue, little tongue coating, and thin pulses. | Mulberry, wolfberry, yellow essence, black sesame, yam |
Examples of dietary prescriptions for children and adolescents with stunted growth
1. Hawthorn malt soup
Main ingredients: hawthorn 5g, malt 15g, dried yam 15g, orange peel 2g, lean pork 100g.
Production method: Wash the hawthorn, malt, dried yam and orange peel to remove the floating dust, soak for 30 minutes, wash the lean pork and cut it into pieces, put all the ingredients into the pot, add an appropriate amount of water, change to medium-low heat and cook for another 30 minutes after boiling, season and eat.
Dosage: You can drink 1 small bowl of soup 30~60 minutes before meals, 2~3 times a week.
2. Lotus seed and barley porridge to strengthen the spleen
Main ingredients: 15g of dried lotus seeds, 15g of dried seeds, 15g of coix seeds, 25g of japonica rice.
Production method: Dried lotus seeds are cored and set aside, coix seeds can be slightly fried or directly purchased fried coix seeds, soaked dried lotus seeds, dried seeds, and fried coix seeds for 30 minutes, washed the japonica rice, put all the ingredients into the pot, add an appropriate amount of water, and cook it to eat.
Dosage: It can be used as a substitute for some staple foods, 2~4 times a week.
3. Walnut longan puzzle porridge
Main ingredients: 5 walnut kernels, 5g dried longan, 5g puzzle kernels, 50g japonica rice.
Method: Peel the walnuts and leave the walnuts for later use. Rinse the dried longan and nootropic kernels. After the japonica rice is washed, add an appropriate amount of water, put all the ingredients in, cook and serve.
Dosage: It can be used as a substitute for some staple foods, 2~3 times a week.
4. Jujube kernel lily pork rib soup
Main ingredients: 5g of sour jujube kernels, 10g of dried lily, 2 jujubes, 100g of pork ribs.
Method: The sour jujube kernels are lightly knocked and smashed and can be packed into a small soup bag. Wash the pork ribs, chop them into small pieces, blanch them and rinse them. Wash the dried lilies, remove the core of the jujubes, and cut them in half for later use; Put all ingredients in a pot, add an appropriate amount of water, simmer for about 1 hour, season and serve.
Dosage: Drink 1 bowl of soup with dinner or before bedtime, 2~3 times a week.
5. Golden poria cake in hawthorn chicken
Main ingredients: 10g of hawthorn, 20g of chicken inner gold, 30g of poria cocos, 30g of yam powder, 20g of black and white sesame seeds, 500g of flour.
Production method: Grind hawthorn, chicken inner gold and poria cocos into powder, mix well with yam powder and flour, add water and noodles, roll out into small thin dough cakes, sprinkle with sesame seeds, and bake in the oven.
Dosage: As a snack, add 2~3 pieces each time after meals.
6. Pork soup with hemp kernels and almonds
30 Main ingredients: hemp seeds 5g, sweet almonds 10g, dried figs 2, pork 100g.
Production method: Wash hemp seeds, sweet almonds, dried figs and set aside, cut the pork into pieces, blanch and wash, put all the ingredients into the pot, add an appropriate amount of water, boil over high heat and then change to medium-low heat and cook for another 40 minutes, season and eat.
Dosage: 1 bowl after a meal, for 2~3 days.
7. Chestnut yam porridge
Main ingredients: 100g fresh yam, 5 chestnuts, 3 jujubes, 50g japonica rice.
Production method: Chestnuts are cooked, jujubes are pitted and washed, cut in half, and fresh yams are peeled and washed and cut into pieces. After the japonica rice is boiled, pour in the chestnuts and jujubes, and simmer for 30 minutes. Add fresh yam and simmer for 30 minutes before serving.
Dosage: It can be used as a substitute for part of the staple food, 1 bowl each time, 2~3 times a week.
8. Milk yam cereal
Main ingredients: 100ml milk, 20g dried yam, 15g coix seeds, 25g oatmeal, 2 jujubes.
Production method: Coix seeds can be slightly fried or directly purchased fried coix seeds, the jujube is pitted, and cut in half. Wash the dried yam and cut it into small cubes. Add an appropriate amount of water to the pot, put the cereal and fried coix seeds, and bring to a boil over high heat. Add dried yams and jujubes and cook until thick, then pour in milk and cook for 5 minutes before serving.
Dosage: It can be used as a substitute for some staple foods, 2~3 times a week.
9. Lamb stew with wolfberries and walnuts
Main ingredients: 100g of mutton, 5 walnut kernels, 3g of wolfberry, 5 slices of ginger, appropriate amount of pepper.
Method: Cut the lamb into small pieces, blanch and wash. Wash the wolfberries and walnuts and set aside. Put mutton, wolfberries, walnuts in the casserole, add an appropriate amount of water, then add pepper, green onion and ginger slices, boil to remove foam, turn to low heat, stew until the meat is rotten, season and eat.
Dosage: Serve with meals, 1~2 times a week.
bibliography
- National Health Commission of the People's Republic of China.Growth standards for children under 7 years old[J].Official website of the National Health Commission of the People's Republic of China.http://www.nhc.gov.cn/
- National Health Commission of the People's Republic of China.Evaluation of height development of children and adolescents aged 7~18 years[J].Official website of the National Health Commission of the People's Republic of China.http://www.nhc.gov.n/
- National Health Commission of the People's Republic of China. Guidelines for food and nutrition for children and adolescents with stunting (2023 edition)[J].Official website of the National Health Commission of the People's Republic of China.http://www.nhc.gov.cn/
- Meng Lingzhe,Xin Ying. Discussion on the etiology of short stature in children[J].Pediatrics of Chinese Integrated Traditional and Western Medicine,2015,6(7):203-207.)
Author: Xu Weishuai, Chief Chinese Pharmacist, Ershadao Hospital, Guangdong Provincial Hospital of Traditional Chinese Medicine
Review: Liang Hualun, Deputy Chief Chinese Pharmacist, Deputy Director of the Pharmacy Department of Ershadao Hospital, Guangdong Provincial Hospital of Traditional Chinese Medicine
Editor: Wen Jialin, Cheng Huanying
Editor-in-charge: Chen Guangtai
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