GROWTH FAILURE IN INSTITUTIONALIZED CHILDREN
GROWTH FAILURE IN INSTITUTIONALIZED CHILDREN
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DOI：
10.1111/j.1540-5834.2011.00629.x
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发表时间：
2011-01-01
影响因子：
9.5
通讯作者：
Gunnar, Megan R.
中科院分区：
文献类型：
--
作者：
Johnson, Dana E.;Gunnar, Megan R.
机构护理环境中的儿童经历了显著的整体生长抑制，这在具有较高基线生长障碍风险的儿童中更为严重（e.例如，在一个实施例中，低出生体重[LBW]婴儿和儿童在子宫内接触酒精）。营养不良以及抑制生长激素-胰岛素样生长因子轴（GH-IGF-1）所造成的社会剥夺可能都有助于在这些环境中的心理社会生长失败的病因。它们的相对重要性和随之而来的临床表现可能与儿童的年龄有关。虽然当孩子被置于一个更有教养的环境中时，身高和体重的追赶性增长是迅速的，但许多因素，特别是青春期的早期发展，会影响最终的身高。生长恢复的潜力在年龄较小的儿童中最大，并且在更多的养育环境中，身高和体重的追赶与照顾者的敏感性和积极关注呈正相关。生长恢复对儿童健康的影响比身高本身更广泛，因为身高的追赶也是认知恢复的积极预测因素。即使生长恢复，下丘脑-垂体-肾上腺系统的持续异常或在发育的关键时期与强劲的追赶性生长相关的微量营养素缺乏的加剧可能会影响或导致幼儿期剥夺的认知，行为和情感后遗症。生长受限婴儿和心理社会发育儿童的研究结果相似，表明在机构环境中经历生长受限的儿童也可能在成年后患代谢综合征（肥胖、2型糖尿病、高血压、心脏病）。必须像关注任何严重削弱儿童能力的疾病一样关注生命早期任何成长环境中的心理社会剥夺。
Children within institutional care settings experience significant global growth suppression, which is more profound in children with a higher baseline risk of growth impairment (e. g., low birth weight [LBW] infants and children exposed to alcohol in utero). Nutritional insufficiencies as well as suppression of the growth hormone-insulin-like growth factor axis (GH-IGF-1) caused by social deprivation likely both contribute to the etiology of psychosocial growth failure within these settings. Their relative importance and the consequent clinical presentations probably relate to the age of the child. While catch-up growth in height and weight are rapid when children are placed in a more nurturing environment, many factors, particularly early progression through puberty, compromise final height. Potential for growth recovery is greatest in younger children and within more nurturing environments where catch-up in height and weight is positively correlated with caregiver sensitivity and positive regard. Growth recovery has wider implications for child well-being than size alone, because catch-up in height is a positive predictor of cognitive recovery as well. Even with growth recovery, persistent abnormalities of the hypothalamic-pituitary-adrenal system or the exacerbation of micronutrient deficiencies associated with robust catch-up growth during critical periods of development could potentially influence or be responsible for the cognitive, behavioral, and emotional sequelae of early childhood deprivation. Findings in growth-restricted infants and those children with psychosocial growth are similar, suggesting that children experiencing growth restriction within institutional settings may also share the risk of developing the metabolic syndrome in adulthood (obesity, Type 2 diabetes mellitus, hypertension, heart disease). Psychosocial deprivation within any caregiving environment during early life must be viewed with as much concern as any severely debilitating childhood disease.