Economic, Racial, and Cultural Influences on the Growth and Maturation of Children

Abstract

1. Elinor A. Graham, MD, MPH* 1. *Associate Professor of Pediatrics, University of Washington, Harborview Medical Center, Seattle, Wash After completing this article, readers should be able to: 1. Understand the differential impact of obesity in children of different races and socioeconomic status. 2. Identify variations in patterns of puberty in different racial groups. 3. Appreciate how race may affect bone age readings and bone density in children. The socioeconomic status of a child’s family, their race as a marker of genetic traits, and family cultural practices all influence the physical growth of children. Understanding the importance of these three factors can help clinicians recognize the wide range of growth variations found in a diverse pediatric population. This review examines these factors in relationship to the adiposity epidemic in developed countries; changes in growth patterns of refugee and immigrant children whose families relocate to developed countries; and racial differences in physical manifestations of puberty, skeletal growth, and bone density. As each of these areas is reviewed, it will be apparent that some unhealthy growth variations affect minority and low-income children disproportionately. Further, many pediatric growth norms have been based on data from European populations that are not representative of the world’s diverse population and must be modified when applied to children of other races. Finally, interventions to prevent practices that may have unhealthy growth outcomes need to be targeted to child populations at greatest risk and to be sensitive to cultural and family lifestyles. Overweight and obesity have increased globally among children, adolescents, and adults and now are recognized by the World Health Organization (WHO) as being one of the most important public health issues. The problem is most prominent in developed countries and in large urban areas. Among developed countries, the United States has the highest prevalence of overweight children and adolescents in the world. The definition of being overweight is based on body mass index (BMI), which is calculated as …