Technical specifications for the management of nutritional diseases in children

The core value of the "Technical Standards for the Management of Nutritional Diseases in Children" is to establish an individualized management path of "screening-intervention-follow-up", which not only avoids growth and development lag caused by nutritional deficiencies, but also alerts to risks such as precocious puberty and metabolic burden caused by excessive supplementation. Currently, in areas where domestic standards are well implemented, the detection rate and intervention effectiveness of nutritional diseases in children have increased by more than 40%.

I have worked in community child care for 7 years, and I have seen too many parents who either think that "the baby is better if they are fatter", or they buy height-increasing drugs when they see that their children are half a head shorter than their peers. This standard is actually a reliable reference line for practitioners and parents, not a rigid standard.

In normal child care, we do not prescribe a full set of examinations for the baby. In addition to routine monitoring of height, weight, and head circumference, we usually only measure hemoglobin and serum 25-hydroxyvitamin D, two mandatory indicators. If parents report that the baby does not eat well, is prone to night sweats, and is always tired after exercise, we will add body composition analysis or trace elements as appropriate. Try not to do any examinations that can be done, and there is no need to let the baby get injections in vain. Last month, I met a mother who brought her 3-year-old baby to the hospital. She said that her baby always woke up at night and needed to check for trace elements. After careful questioning, she found out that her baby sleeps for two hours at 4 pm every day and doesn’t go to bed until 11 pm. After adjusting her schedule, her sleep problem was solved directly, and there was no need to supplement this or that.

When it comes to supplements, there is indeed a lot of controversy in the industry. For example, vitamin D supplementation. The guidelines of the Children's Health Branch of the Chinese Society of Preventive Medicine recommend routine supplementation until the age of 18, with 400IU per day. However, many clinical experts have also suggested that if children are exposed to the sun outdoors for two hours a day, There is enough deep-sea fish and egg yolk in the diet. After the age of 3, there is no need for routine supplementation. Serum 25-hydroxyvitamin D levels can be monitored once every six months. Both views are supported by large sample clinical data. There is no right or wrong. Just adjust according to each child's living habits. There is also intervention for iron deficiency anemia. If the child's hemoglobin is between 100-110g/L and there is no severe picky eating problem at ordinary times, we usually recommend dietary supplements first, eating more red meat, pork liver, and blood tofu. If the index is up during the reexamination after two weeks, iron supplements are not needed - after all, iron supplements are very irritating to the gastrointestinal tract. Many children suffer from constipation after eating, and they cannot suffer this crime just to supplement some iron. However, if the hemoglobin has been lower than 100g/L, or the child has lost appetite and has difficulty concentrating, it is still recommended to supplement iron in a timely manner to avoid long-term iron deficiency affecting cognitive development. There is no high or low distinction between the two options. The core is to adapt to the actual situation of the child.

I also encountered a typical case of obesity in the past two years. The BMI of a 5-year-old boy has reached 18.5, which is considered overweight. When the parents came, they told him to "cut out meat and lose weight" and only allowed him to eat vegetables every day. As a result, the boy cried for half a month and did not lose weight. Instead, he learned to secretly hide snacks. At that time, we referred to the opinions of two groups of experts: One group believed that children under 6 years old should not mention the concept of "weight loss" to avoid inducing eating disorders. As long as the weight is maintained and the height does not increase, the height will naturally grow evenly. ； The other group believes that if the child has been diagnosed with mild hyperlipidemia, completely letting it go will increase the risk of metabolic diseases in adulthood. In the end, we chose a compromise plan. We did not limit the total calories. We just replaced the sugary drinks he drank every day with plain water, replaced the fried chicken three times a week with steamed fish, and let him run downstairs with the children for half an hour every afternoon. In half a year, his height increased by 4 centimeters, his weight only increased by 1 pound, his BMI naturally dropped to the normal range, and his blood lipids returned to normal. The child did not feel that he was being "controlled by diet" throughout the process, and he no longer secretly hid snacks.

Of course, there are also regrettable situations. Last year, a grandma brought her 2-year-old baby. The baby was already moderately malnourished and weighed 2 kilograms lower than the standard for the same age. We suggested adjusting the diet and supplementing with an appropriate amount of zinc. The grandma insisted that the baby had "spleen deficiency" and had to go home to drink spleen-strengthening soup. It took two months for her to come back for a follow-up consultation. Although the weight caught up after more than half a year of intervention, she was still about 1 cm shorter than her peers, which is a pity.

Many parents ask me if this standard is only for doctors. In fact, it is not. The core logic can also be obtained by ordinary parents: don’t give your baby any Internet celebrity nutrition packs or height-increasing nutrients. Pay more attention to your baby’s eating, defecation, and exercise status. Go to childcare on time. If you have any questions, talk to the doctor. It is much more reliable than searching for half-night remedies online. By the way, there is another common misunderstanding that needs to be mentioned. Many people think that nutritional diseases are "lack of nutrition." In fact, the proportion of overnutrition problems such as overweight, obesity, and hyperlipidemia in children has almost caught up with malnutrition. Don't always focus on "supplements." A balanced diet and exercise is the most effective nutritional prescription.