Chinese Children Are Different

Introduction
Chinese children look different from children of other ethnic origins. Their health problems and disease menifestations are often different too. It is therefore important for child health workers to understand such differences and to be able to provide the appropriate care and sometimes the special needs for Chinese children.

Common misconceptions
Misunderstanding and misconception still exist among many overseas workers. Many think that Chinese children are born small and remain small all through childhood. Others think that most Chinese children look "Mongoloid". Most workers still believe that Chinese are born yellow and that there may be many other exotic genetic illnesses. There is a need for more research and for more easily retrievable scientific reports to dispel these misunderstandings and misconceptions.

Indices of child health
Child health indices from places with Chinese people, including places like Hong Kong, had been similar to other developing communities. These however are becoming history with modernization and socio-economic improvements. Take Hong Kong as an example, the infant mortality rate which was around 100 per 1000 live birth in the immediate post-World War II period, has dropped to only 2.9 per thousand in 1999/2000. Such dramatic improvement was not entirely due to progress of social economic conditions but also to a very successful immunization program.

Another very noticeable example is the change in deaths related to bacterial pneumonia. In years past, at least 10% of infants would not live beyond the first year because of fatality from pneumonia. In more recent times however, less than 20 per 100,000 infants would die because of the disease. Such improvements are probably the result not only of improvement of social economic conditions but in particular also of the advent and availability of new generations of anti-microbials.

Difference of communicable or infectious diseases
Most of the highly infectious and often fatal conditions have been under control. Examples include whooping-cough, tetanus and poliomyelitis, deaths from these diseases have nearly completely disappeared. Deaths directly or indirectly related to measles have also become rare. Diarrhoeal disorders causing significant mortality in the past has also become a rarity, most probably because of availability of potable water supply, and improvement in sanitation; it has certainly nothing to do with the marked decrease in breast-feeding in recent two decades, which would have produced an opposite effect in the West.

Childhood pulmonary tuberculosis is usually regarded as not easily spread to infect others. However, instances of sputum-positive and coughing young infants who are apparently infectious requiring isolation have been encountered. Such obvious difference in Chinese children could be related to the high frequency of repeated contacts with the infectious agent due to over-crowding and communal eating/feeding habits resulting in many children developing post-primary form of pulmonary tuberculosis, not too different from adults.

Infectious mononucleosis which is usually a highly prevalent disease among teenagers in the industrialised world, is uncommon in Chinese children. This may be due to exposure to the infectious agent in a much earlier age from traditional living and feeding habits, altering and maturing the immune system, rendering the classical manifestation of infectious mononucleosis syndrome an uncommon feature. Such enhanced immunity may also explain the relative infrequent occurrence of invasive haemophilus influenzae infection in our children also.

Conditions Related to Traditional Practices

  1. Feeding - The traditional Chinese weaning diet tends to provide the young infants with nutritional intake which is sub-caloric and low in a number of nutritive ingredients. In addition, traditional belief in many foods that could provoke undesirable hot, cold, toxic body reactions, etc. has resulted in restricting the choice of "neutral foods" further reducing the intake in many infants. All such practices with their resultant smaller stature have projected the wrong impression that Chinese children are "born and remain" small.

  2. Use of Chinese herbs - This practice is very deep-rooted in the average Chinese household. A number of herbs frequently used in the neonatal period "to cleanse the infant of pregnancy-related toxins" have been shown to displace bilirubin from protein binding. In addition, some herbs, notably Chuen-Lien, have been found to induce acute hemolysis in G6PD deficient subjects. Such findings have offered an explanation to the high prevalence of kernicterus in the jaundiced term infants in the past. Other herbs may possess beneficial effects; more scientific studies are needed to prove their efficacies.

  3. Acupuncture/Moxibustion, etc. - Interesting scientific observations have been available recently, confirming and refuting some of the alleged effects of these traditional therapies. Earlier problems of "blood-borne diseases" have become eradicated when proper sterilization or disposable needles were adopted.

  4. Counter-irritant therapies - Topical application of counter irritant is widely practiced. Besides producing frequent skin reactions, multiple bruises from "scraping wind" have been mistaken for child-abuse also.

  5. Miscellaneous -

    1. Covering the umbilical stump of newborn to avoid exposure is a deep-rooted problem. It does not only encourage overt and sub-clinical infection to occur, it may also enhance bilirubin cytotoxicity through provoking inflammatory cytokine response, as shown in a recent study.

    2. Food therapies - Many foods are believed to produce therapeutic effects. Notable examples include Ginseng as a tonic, game meats to keep warm, "longevity-fish" for wound-healing, etc.

Genetic/Ethnic Disorders
Interestingly, the most prevalent chronic lung problem - cystic fibrosis, in the Western children, is but a rare occurrence in Chinese, especially Southern Chinese. Whether "bad gene" has been weeded out or co-factors for the genetic expression have been altered in Chinese need further exploration.

Thalassaemia syndromes and erythrocyte G6PD deficiency are prevalent in Southern China. Severe hemolytic crisis occurs frequently. Provoking factors have included such traditional practices as herbal-tea drinking, use of naphthalene moth-balls and cross infections from over-crowding living conditions, etc. Mongolian blue spots are present in the majority of Chinese newborn infants.

Congenital dislocation of hips, pyloric stenosis, posterior urethral valve and neuro-tube defects are uncommon in Southern Chinese. The latter condition could be related to the abundance of vegetables with adequate folate content in the diet; with the recent trend of changing diet, it may not be surprising to encounter more neural tube problems in the near future.

Environment Related Problems
Over-crowded and sub-sanitary conditions together with sub-optimal nutrition and health care would have contributed to increased stresses to the pregnant women resulting in recurrent fetal adrenal responses. Such reactions may offer a protective effect in reducing the development of hyaline membrane disease in the immaturely born infants.

These conditions may also enhance and sustain the herd immunity to account for the scarcity of hypertrophic tonsils, less acute otitis in young children and much less infectious mononucleosis syndrome in the adolescents. Similar protective effect may exist against the development of Sudden Infant Death Syndrome. All these remain to be proven.

Perspectives
More work needs to be done to repeat and confirm observations on the differences in Chinese children. Much more research is required to improve our understanding of these differences. A web-site to collect and collate this information appears a most appropriate step to undertake at this point.

September 2001


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