Growth concerns of Children

Infant and Children, Teenages | May 25, 2017 | Author: Naturopath

Children

Growth concerns of Children

If your child is shorter or smaller than their peers, you might be wondering if they have underlying physiological issues. Serious growth conditions are generally picked up at birth or during infancy and, by and large, nutrition and genetics play the biggest roles in determining your child's size and when they'll go through growth-spurts.

While each generation is growing taller than the one preceding it, genetics still determines where kids sit in comparison to their peers on the height & size chart. There is a slim chance that your child will be more of a Michael Jordon if their biological parents were more akin to Danny DeVito.  Seek advice from a paediatrician on what to expect, and be realistic with your hopes for your child's growth.

There are a few manageable influences that can impair growth in childhood, including underlying nutritional insufficiencies and diseases that can present with subtle symptoms:

Hypothyroid Disease

growth The thyroid is a butterfly-shaped gland located at the front of the throat, just below the Adam's apple. It secretes hormones that control metabolism and growth, and an under-active thyroid or “hypo-thyroid” can result in growth issues in children. Other symptoms can include poor appetite, delay in the appearance of teeth, constipation, poor concentration, and short fingers and toes.

Hypothyroid disease is usually detected by paediatricians, but ask for your physician's opinion if you're worried.

Coeliac Disease

Coeliac (“see-lee-ack”) disease is an autoimmune condition. When people with coeliac disease eat gluten, their immune systems attacks part of the lining of their small intestine that is responsible for absorbing nutrients. Because of this destruction, coeliac disease results in impaired nutrition and reduced growth in children.

Early diagnosis is essential as missing out on key nutrients results in failure to thrive (aka poor growth). Other coeliac symptoms can include diarrhoea, low energy levels, emotional distress or mood swings, and poor appetite, but coeliac disease can present “silently” with no symptoms except for growth issues.

Gluten & Other Food Intolerances

All food intolerances can interfere with the body's ability to absorb nutrients from food and lead to growth problems in children.

growth food intoleranceGluten intolerance is different to coeliac disease – it doesn't trigger autoimmune destruction of the small intestine, but it does cause the gastrointestinal tract to become inflamed. This inflammation blocks the uptake of nutrients, and uses more nutrients to try to calm down the inflammation. Food intolerances can present with similar symptoms to coeliac disease including growth problems, diarrhoea, runny noses and frequent infections, and abdominal tenderness.

Gluten and dairy are the most common food intolerances in children, and a recent study showed that a high gluten diet disrupted growth hormones in children, regardless of whether or not they had an established intolerance [1].

Opting for gluten-free grains like rice, millet, quinoa and buckwheat can give your child a break from gluten, and dairy can be replaced with rice, oat, coconut, or soy products. Seek advice from a nutritionist to ensure their nutritional levels are being met during any dietary changes.

Nutritional Insufficiencies

growth fussy eatersPicky eaters and those on restricted diets due to health conditions, cultural limitations or parent’s ethics are at risk of developing nutritional deficiencies that restrict growth. But even a mild insufficiency (where the levels aren't low enough to constitute a “deficiency” but are below optimal range) can compromise growth outcomes in children.

Multiple studies have shown that picky eaters are at risk of deficiencies in minerals, vitamins and total energy intake, potentially accounting for growth issues amongst these kids [2] [3]. Most picky eaters seem to prefer to eat cereals and grains but still fail to meet the recommended daily intake of these foods, missing out on key nutrients for growth like protein, magnesium and zinc. The case is worse for vegetables, with one study showing that only 14% of picky eaters come close to getting the recommended intake [4].
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For a child to thrive, all essential nutrients are required in adequate amounts. Generally, children's diets are low in these key growth nutrients:

Protein

Protein deficiencies are incredibly rare in Australia, but some kids are getting well under the recommended levels that they need to thrive. Protein is necessary for all functions in the body, including muscle growth, bone formation, metabolism, and the production and section of growth-related hormones. Low height is often due to inadequate protein intake during peak growth times.

Adequate intake is calculated depending on the ideal weight of the child:

4 – 8 years 0.91g/kg per day (approx. 20g protein per day)

9 – 13 year 0.94g / kg per day (approx 40g per day)

14 – 18 years (0.99g / kg per day (approx 65kg per day).

For reference, 1 cup of quinoa contains 8g of complete protein.

growth proteinRed meat is the first thing most people think of when they look for “protein”, but variety is the key to a healthy diet for growing children.

Eggs are a fantastic source of protein for kids, and fish also provide healthy fats and iodine, a nutrient needed for thyroid health. Plant-based options add extra nutrients – include lentils, chickpeas, whole grains, nuts and nut butters, tofu, tempeh, quinoa or chia seeds at every meal.

Try to keep snacks high in protein too, with options like hummus dips, nuts, cheese and hard-boiled eggs.

Vitamin D

Vitamin D regulates healthy growth hormones, and controls the absorption and excretion of essential bone minerals such as calcium. Low levels of vitamin D have been linked to poor growth outcomes in children, and one study showed that this was followed with unhealthy weight gain during adolescence [5].

growth vitamin dTen minutes of sun exposure on bare arms and legs (without sunscreen) is, for most kids, enough to create vitamin D to help maintain bones. Vitamin D deficiency is a global problem, in even the sunniest parts of the world like Australia. Those with immune issues, endocrine condition, kidney or liver problems, or already-low vitamin D levels may need some extra help – vitamin D supplements give the body vitamin D in a form that is already activated.

Check with your nutritionist or physician on whether you need to supplement and how much – some blood may need to be taken to check levels before beginning supplementation. Sprays and drops are more absorbable than capsules, but consider your child’s compliance when deciding which supplement to purchase – sprays and drops are more fun, are usually tasteless or pleasantly flavoured, and easy to administer.

With its role in mineral homeostasis, a vitamin D deficiency often comes alongside insufficiencies of other nutrients involved in growth, particularly calcium, zinc, magnesium and copper [6].
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Calcium

growth calciumCalcium is the most recognised mineral when it comes to bones. 99% of calcium is bound up in bones and teeth, but the remaining 1% is used for essential growth functions like cellular energy production, muscle function, and secretion of growth hormones. There is more to it than drinking plenty of milk. Tofu, eggs, tahini and dairy are rich sources of calcium. Fortified soy milk, cooked leafy vegetables and yoghurts are good too.

Get rid of soft drinks, particularly those that are dark in colour, as they contain phosphoric acids which block integration of calcium into the bone.

Australian recommended daily intakes of calcium:

            Ages 4 – 8 :    7,00mg per day

            Ages 9 – 11:    1,000mg per day

            Ages 12 – 18: 1,300mg per day

Source: NHMRC [7]
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Magnesium

Magnesium creates a foundational structure with calcium to make bones strong and long. They also work together to regulate nerve signals throughout the brain and the entire nervous system. Magnesium also regulates vitamin D levels, which in turn regulates calcium levels and growth outcomes in children.

Magnesium is quickly excreted from the body during times of stress including the physical stress of growth, so boost your child's dietary intake with lots of green leafy vegetables, brown rice and other whole grains, legumes, nuts and seeds. Supplement is generally considered safe, but consult with a healthcare professional to make sure it's right for your child. Topical application is also suitable. Try a roll on or use some magnesium flakes in their bath a few times a week.
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Australian recommended daily intakes of magnesium:

Ages 4 – 8 :                 130mg per day

Ages 9 – 13:                240mg per day

Ages 14 – 18 : 410mg for boys and 360mg for girls, per day

Source: NMHRC [8]

Zinc

Zinc is an essential mineral that is required for growth of all tissue, healthy cell devision, and regulation of metabolism. On a microbiological level, zinc is required for DNA synthesis and protein attachment, without which cells can't replicate and tissue can't grow.

growth zincEven a mild deficiency in zinc can contribute to reduced height, and often comes along with reduced immune strength, frequent sniffles and sneezes, and poor ability to concentrate or give attention.

A recent meta-analysis of 33 trials showed that prepubertal children who took zinc supplements were far more likely to experience healthy height and weight gain, while maintaining ideal BMIs [9].

It's essential to seek advice from a qualified health care professional before giving zinc supplementation to your child, as too much zinc can be toxic. In the meantime, boost their levels with zinc-rich foods. The highest known food-source is oysters… Not exactly a fun lunchbox snack. But good levels are also found in meat, eggs, nuts and seeds.

Australian recommended daily intakes of zinc:

Ages 4 – 8 :                 4mg per day

Ages 9 – 13:                6mg per day

Ages 14 – 18 : 7mg per day

Source: NMHRC [10]
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References

[1] Delvicchio, M., et al. (2010) Anti-Pituitary Antibodies in Children With Newly Diagnosed Celiac Disease: A Novel Finding Contributing to Linear-Growth Impairment. American Journal of Gastroenterology, 105, 691 – 696.   http://www.nature.com/ajg/journal/v105/n3/full/ajg2009642a.html

[2] Dubois L, Farmer AP, Girard M, Peterson K. Preschool children’s eating behaviours are related to dietary adequacy and body weight. Eur J Clin Nutr. 61, 846 - 55.

[3] Galloway AT, Fiorito L, Lee Y, Birch LL. Parental pressure, dietary patterns, and weight status among girls who are “picky eaters”. J Am Diet Assoc., 105, 541-8.

[4] Volger, S., et al. (2017) Nutrient intake and dietary patterns in children 2.5-5 years of age with picky eating behaviours and low weight-for-height. Asia Pac J Clin Nutr., 26:1, 104 – 109.

[5] Kremer, R., et al. (2009) Vitamin D Status and Its Relationship to Body Fat, Final Height, and Peak Bone Mass in Young Women. J Clin Endocrinol Metab., 94:1, 67 – 73. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2630864/

[6] Shams, B., et al. (2016) The relationship of serum vitamin D and Zinc in a nationally representative sample of Iranian children and adolescents: The CASPIAN-III study. Med J Islam Repub Iran., 30, 430.

[7] NHMRC (2014) Nutrient Reference Values for Australia and New Zealand – Calcium. https://www.nrv.gov.au/nutrients/calcium 

[8] NMHRC (2014) Nutrient Reference Values for Australia and New Zealand – Magnesium. https://www.nrv.gov.au/nutrients/magnesium

[9] Brown, K., et al. (2002) Effect of supplemental zinc on the growth and serum zinc concentrations of prepubertal children: a meta-analysis of randomized controlled trials. American Journal of Clinical Nutrition, 75:6, 1062 – 1071 http://ajcn.nutrition.org/content/75/6/1062.full

 [10] NMHRC (2014) Nutrient Reference Values for Australia and New Zealand – Zinc. https://www.nrv.gov.au/nutrients/zinc

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