CY Yeung

Chinese children look different from children of other ethnic origins. Many studies have also indicated that there are differences in disease patterns and in a number of child health issues.

Chinese traditional practices have significantly influenced child health. Infant feeding practice is a good example. Growth faltering used to commence around the weaning period. Such an effect has faded in recent years among the less traditional nuclear families. The generally over-protective attitude towards children is probably another significant factor contributing to the much less prevalent rate of accidents compared with Western communities where children are brought up in a much more permissive environment. Traditional beliefs in alternative medicines have also generated a number of health problems which are unique to Chinese. Many herbs that have been popularly used in the neonatal period have been found to adversely affect these infants, producing jaundice and enhancing the risk of brain damage by displacing bilirubin from protein binding. Other herbs have been demonstrated to possess beneficial effects. Many other traditional practices also have significant effects on child health.

Certain childhood genetic disorders are particularly prevalent amongst Chinese, for example glucose-6-phosphate dehydrogenase (G6PD) deficiency and thalassaemia syndromes. Acute haemolytic crisis occurs in G6PD-deficient subjects during infections, especially with hepatitis and Salmonella typhi. Herbs for therapeutic and tonic usage, together with naphthalene mothballs used as insect repellent to preserve winter clothing, are also frequently encountered as precipitating factors for acute haemolytic jaundice in infants and children.

A number of neonatal disorders have been found to occur much less frequently in Chinese. Many factors, particularly environmental and stressful conditions, have been related to this. Notable examples include respiratory distress syndrome, recurrent apnoea in premature babies and persistent pulmonary hypertension. Findings of relatively mature immune systems in Chinese infants offer an additional explanation for the relative scarcity of sudden infant death syndrome, which occurs 80 times less frequently than in the West. Central neural tube defects also occur much less frequently, for no obvious reasons. These factors together should project progressively improving neonatal and infant mortality results in the continually developing Chinese communities. Several childhood conditions are much less common in Chinese than Caucasians: insulin-dependent diabetes mellitus is one, congenital dislocation of the hip is another and cystic fibrosis yet another. Some infective conditions are also surprisingly less common, they include invasive Haemophilus influenzae type b infections like acute epiglottitis and meningitis, and infectious mononucleosis syndrome. Early antigenic stimulation related to traditional habits may be an explanation.

In conclusion, most of the differences in health problems seen in Chinese are related to differences in the environment or to traditional practices, although genetic factors also play a role.