Dr. Suat Günsel University of Kyrenia Hospital Paediatrician Prof. Dr. Rüveyde Bundak stated that the most important factor that differentiated adults and children is that children are constantly growing, developing and changing, and compared to other living creatures the childhood stages in humans is longer and that this era lasts up to 16-18 years starting from the fertilisation to the end of their teenage years.
Prof. Dr. Bundak who made a statement with regards to the 15th of May Monitoring Growth Day said that growth is the increase of the body mass and volume and also stated that development was a term used to define the biologic changes occurring in the structure of the cells and tissues, drawing attention to the fact that situations that affect the child’s health also has an effect on their development and growth, it can either fully stop or hinder the growth and development.
GROWTH PHYSIOLOGY, EFFECTING FACTORS
Prof. Dr. Bundak stated that the growth period is an important continual aspect of the childhood years and any underlying disease can cause the growth to stop. The fastest growth period is the pre-birth (intrauterine) period. As well as genetic factors, hormones, growth factors due to tissue, nutrition and factors due to the mother can affect the pre-birth growth period.
Prof. Dr. Rüveyde Bundak continued:
‘’The genetic structure that the child develops during the fertilisation determines their development potential. If the mother smokes and drinks alcohol, has a viral infection, is subjected to radiation, uses medication, and has a defect in their wound structure and other such factors effect growth and development. The post-birth growth happens in three steps: Infancy, childhood and puberty. Infancy is the continuation of the fast growth in the intrauterine period and the most effective factor at this stage is nutrition. The childhood growth starts at around 18 months and the most effective growth factor during this stage is the growth hormone. Puberty starts at around the age of 10-12 and occurs through the gender steroids. The thyroid hormones are effective at each stage. The fastest growth occurs during infancy. If a child does not have enough nutrition and does not grow much in this stage then they begin their childhood growth period from the bottom end of the chart and even if they continue at a normal growth speed, they will still end up as shorter than normal. As a result; nutrition in the first 12-18 months is a factor that greatly affects the height of the child. The generally consistent speed of growth during the childhood years (~ 5 cm/year) speeds up during puberty. Middle childhood growth speeds up at the ages of 6-7 occur due to weak androgens such as dehidroepiandrosterone that is discharged from the glands above the kidneys.
PSYCHOSOCIAL FACTORS EFFECT GROWTH
Another factor that affects growth is genetics. The birth weight is affected by intrauterine factors rather than the genotype. A child enters their era of growth that matches their genetic potential after 12-18 months and then continues in that era.
Psychosocial factors affect growth either due to reduction of nutrition or suppression of hormones such as the growth hormone. Nutrition affects growth in every stage but especially affects people in their breastfeeding and teenage years where the growth is faster.
Girls and boys reach 80% of their final height at the beginning of puberty. One of the most important factors of puberty is that it speeds up growth. By the end of puberty both genders complete 99% of their growth. Girls grow 15-20 cm during puberty and boys grow 25-28 cm, growth stops when the bones have become mature and the cartilage closes around the age of 16 in girls and 18 in boys. The age when puberty starts and the speed at which it develops, determines the final height of that person.
MONITORING AND EVALUATING GROWTH
Monitoring growth is defined as evaluating the child’s growth from their birth all during their childhood stages at certain intervals. This is why children must be evaluated in terms of growth and development once a month during their first 6 months, once every 3 months between 6 months-2 years, once every 6 months between 3-6 years and once every year from the age of 6 until their growth is complete. The aim is to find the problems that might affect child growth early on, treat and intervene with the problem if it is a preventable cause. The child’s weight, height and head diameter are evaluated as measurements. The growth speed is determined through these measurements. Their body mass index or BMI [weight (kg)/height squared (m2)] can be calculated. If their height is short then the body proportions must be checked. The rate between the seating height and the overall height, the rate of head to pubis and pubis to feet and the arm span is compared.
The measurements taken from the child are compared to the standard growth charts that have been made up through data from healthy children and are evaluated.
The World Health Organisation (WHO) stressed the need for an international growth standard in 1978 and determined international standard measurements. These standard values must be prepared by taking sample measurements from children who are healthy, samples from at least 200 children from different age and gender groups, the measurements must be taken by trained personnel with standard equipment, and suitable mathematical methods must be used to determine their margin of error.
Well trained health staff are needed to monitor growth. Training is needed in many areas such as; determining their calendar age, taking the measurements correctly, marking up and evaluating the measurements; and the staff must be able to form good relationships with the families so that they can freely share their problems and worries to them as a health consultant. Also when the problem is found, they can be referred to a specialist.