Childhood obesity

Dr. Simona Șofariu is a pediatrician and endocrinologist. Since 2008 he has dedicated his activity to young patients in the Emergency Department of the Sibiu Pediatric Clinical Hospital, whose activity he coordinated until 2017. From 2019 he works in the hospital outpatient clinic where he offers consultations in endocrinology and pediatrics. She is married and has two children. In an interview with the Council Tower, the doctor talks about endocrinological disorders in children, about the signs that parents should pay attention to and how obesity can be combated in children.

I want to ask you, first of all, what are the most common hormonal disorders in children and adolescents?

The most common endocrine disorders in children are growth disorders, overweight and obesity, vitamin D deficiency, puberty disorders or thyroid disorders.

How can parents know that something is wrong?

Regarding the growth disorders, the first question marks appear when we compare our children with their colleagues in the community and we find that they are either among the youngest or among the oldest in the group. Each child should be measured at least once a year, and these measurements should be noted so that the endocrinologist can assess the annual rate of growth. The expectation of raising children is dependent on age, a more accelerated growth occurring in the first two years: in the first year of life it gains about 25 cm; between the ages of 1 year and 2 years they grow on average 12.5 cm. Subsequently, the growth rate decreases (5-6 cm / year between 4 years and puberty) until the onset of pubertal growth (9.5 cm / year in boys and 8.3 cm / year in girls). At the first suspicion of inadequate growth, endocrinological consultation should be performed. The causes of short stature are many, one of which is growth hormone deficiency. Growth hormone treatment can be started after the chronological age of three years and stops at a bone development age of 14 years in girls and 15 and a half years in boys. The age at which the patient presents to the doctor dictates the success of the treatment.

And in the case of puberty?

Regarding the development of puberty, any secondary sexual character (appearance of the mammary glands, axillary and pubic hair) that appeared in girls before the age of 8 and in boys before the age of 9 must attract the attention of parents and address for consultation.

At what age could thyroid problems occur?

Thyroid pathology can occur in children at any age and is more common in adolescence in females. In the maternity ward, all newborns are tested for thyroid function by collecting a drop of blood from the heel, and screening for congenital hypothyroidism. Newborns diagnosed with congenital hypothyroidism should start hormone replacement therapy as soon as possible to facilitate normal development of the nervous system. Signs and symptoms of acquired hypothyroidism set in slowly, insidiously, are less severe than those of congenital hypothyroidism: short stature, delayed growth, delayed bone age, dry skin, delayed puberty or early puberty, delayed dentition and deficient concentration, deficient concentration.

The leading cause of acquired hypothyroidism is Hashimoto’s autoimmune thyroiditis.

What can you tell us about vitamin D deficiency?

Regarding bone mineralization, if the signs of rickets (frontal bumps, flared thorax, deviation in the lime or valgus of the knee) are obvious in young children, vitamin D deficiency is much more common in adolescents. If the fast-growing infant receives vitamin D supplementation, in adolescents, although there is the same accelerated growth, the administration of vitamin D, although necessary, is not a common practice. Adolescent bone mass is formed in adolescence, vitamin D deficiency is an important factor in bone mineralization disorders and then later osteoporosis. In the Clinical Hospital of Pediatrics, the level of vitamin D 25 OH is tested by detecting the deficiency and monitoring the effectiveness of the treatment. Children with associated pathology (obesity, epilepsy, diabetes) have an increased need for vitamin D and require annual dosage of vitamin D 25 OH.

And if you’re talking about obesity, what do extra pounds mean to children?

Overweight and obesity are, according to the WHO, the fifth largest public health problem in the world, exacerbated by restrictions on the COVID-19 pandemic. Unlike the adult where the adipocyte increases in volume, in children both the volume and the number of fat cells increase. Pediatric obesity therapy requires the involvement of the whole family. Moderation and balance are the basic rule when it comes to nutrition. The child needs education and food discipline with simple rules, which must be respected by both children and adults. The meal is an important moment and it will be served, preferably with the family, because the child needs first of all attention and affection. Let’s not forget that parents are the role models for their children! Sweets are not a food. In order to avoid weight gain, the child should consume few sweets. Children need to understand that everything that is dessert is a treat for pleasure and should not be part of the daily diet. Childhood obesity predisposes to increased incidence of cardiovascular, osteo-articular, diabetes, pubertal disorders. To prevent obesity with a balanced diet, it is important to encourage children to exercise, walk and exercise for at least 60 minutes / day!

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