Abstract
Already the founders of pediatrics at the turn of the 18th and 19th centuries knew that children from rich and educated families are larger than poor and uneducated children. This difference was first leveled out in the 1960s in Scandinavia, where the model of the European welfare state with the practical elimination of poverty prevailed first and most strongly.
Pediatricians soon realized that growth before birth and throughout childhood was determined by the availability of energy, protein and micronutrients. And that therefore, fetuses and children exposed to proteoenergetic malnutrition, vitamin D and calcium deficiency, sideropenia and iodopenia grow little.
By improving socio-economic conditions and nutrition, together with the introduction of nationwide intervention programs (antirachitic prevention, salt iodination), the negative nutritional effects on child growth have been overcome in the vast majority of the world. This was best seen during the 20th century on the gradually rising curves of percentile graphs - the term "secular acceleration" was used for this phenomenon.
However, the third percentile persisted, albeit shifted higher. Under the third percentile, we began looking for children suffering from an unrecognized somatic disease.
Pediatric endocrinologists began lecturing and writing that growth is the best indicator of children's health and that children with unrecognized Crohn's disease, celiac disease, renal insufficiency, tubular disorder, hypothyroidism, diffuse lung disease, or systemic inflammation do not grow well. Differential diagnosis of growth retardation began to overlap with the whole pediatrics of chronic diseases.
Over time, pediatricians have learned to recognize these diseases in time - before growth retardation develops. If such a child is diagnosed today only on the basis of a growth disorder, we perceive it as a failure of the system or the family.
After all, 7 years ago, American authors first announced that the search for somatic disease in the diagnosis of short stature ceases to be effective.