Fenton Tanis R, Gilbert Nicole, Elmrayed Seham, Fenton Carol J, Boctor Dana L
Community Health Sciences, O'Brien Institute of Public Health, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Institute of Global Health and Human Ecology, American University in Cairo, New Cairo, Egypt.
Ann Nutr Metab. 2024;80(Suppl 1):7-17. doi: 10.1159/000541226. Epub 2024 Nov 27.
Growth assessments are a pillar of public health surveillance, individual health screening, and clinical care. Normal growth is defined differently for individuals versus populations. The World Health Organization (WHO) growth standards were developed to describe the pattern of growth in healthy children without socioeconomic limitations whose mothers planned to breastfeed. The growth standards' cut-off points of ±2 standard deviations (z-scores) were defined for population assessments, based on attained size, to describe stunting and wasting at the lower end and overweight at the higher end. In a healthy population, one would expect 2.3% of the population to be above and below these cut-points. Higher child mortality rates associated with higher rates of stunting and wasting noted in observational studies validated these WHO cut-offs. There are knowledge gaps influencing the accuracy and effectiveness of growth assessments in individual children, posing challenges for health care providers.
The principles of assessing normal growth in children and preterm infants are reviewed, along with pitfalls to be avoided. Growth is determined by genetics and modified by the interplay with nutritional, environmental, socioeconomic, and possibly intergenerational factors. This complexity is reflected at both the population and individual level. However, normal growth in an individual has unique-specific factors so requires a comprehensive assessment. Normal growth for an individual child could be defined as the progression of changes in anthropometric measurements to achieve the individual's genetic potential. A misdiagnosis of growth faltering can occur if infants and children are assessed with one-time rather than serial measures, and if age is not corrected for prematurity. Health care provider sensitivity and cognizance when communicating about a child's size is important for parental reassurance and avoiding stigma and unnecessary pressures or restrictions around feeding.
生长评估是公共卫生监测、个体健康筛查和临床护理的支柱。个体与人群的正常生长定义不同。世界卫生组织（WHO）生长标准旨在描述没有社会经济限制且母亲计划母乳喂养的健康儿童的生长模式。基于所达到的尺寸，为人群评估定义了±2个标准差（z分数）的生长标准切点，以描述低端的发育迟缓与消瘦以及高端的超重情况。在健康人群中，预计有2.3%的人口高于或低于这些切点。观察性研究中指出的与较高发育迟缓和消瘦率相关的较高儿童死亡率验证了这些WHO切点。存在一些知识空白影响个体儿童生长评估的准确性和有效性，给医疗保健提供者带来了挑战。
回顾了评估儿童和早产儿正常生长的原则以及应避免的陷阱。生长由遗传决定，并通过与营养、环境、社会经济以及可能的代际因素的相互作用而改变。这种复杂性在人群和个体层面都有所体现。然而，个体的正常生长有其独特的特定因素，因此需要进行全面评估。个体儿童的正常生长可定义为人体测量学指标变化的进展，以实现个体的遗传潜力。如果对婴儿和儿童进行一次性而非系列测量，并且未对早产进行年龄校正，可能会误诊生长发育迟缓。医疗保健提供者在交流儿童体型时的敏感度和认知度对于安抚家长以及避免围绕喂养的污名化和不必要的压力或限制很重要。
