Lately, it seems as though your child is looking up to
classmates - literally. The other kids in the class have been
getting taller and developing into young adults, but your
child's growth seems to be lagging behind. Classmates now tower
over your child.
Is something wrong? Maybe, maybe not. Some kids just grow more
slowly than others because their parents did, too. But others may
have an actual growth disorder, which is any type of problem that
prevents kids from meeting realistic expectations of
growth
, from failure to gain height and weight in young children to short
stature or delayed sexual development in teens.
Variations of Normal Growth Patterns
A couple of differences seen in the growth patterns of normal
children include these common conditions, which are
not
growth disorders:
Constitutional growth delay:
This condition describes children who are small for their ages but
who are growing at a normal rate. They usually have a delayed
"bone age," which means that their skeletal maturation is
younger than their age in years. (Bone age is measured by taking an
X-ray of the hand and wrist and comparing it with standard X-ray
findings seen in kids the same age.) These children don't have
any signs or symptoms of diseases that affect growth. They tend to
reach puberty later than their peers do, with delay in the onset of
sexual development and the pubertal growth spurt. But because they
continue to grow until an older age, they tend to catch up to their
peers when they reach adult height. One or both parents or other
close relatives often had a similar "late-bloomer" growth
pattern.
Familial (or genetic) short stature:
This is a condition in which shorter parents tend to have shorter
children. This term applies to short children who don't have
any symptoms of diseases that affect their growth. Kids with
familial short stature still have growth spurts and enter puberty
at normal ages, but they usually will only reach a height similar
to that of their parents.
With both constitutional growth delay and familial short
stature, kids and families need to be reassured that the child does
not
have a disease or medical condition that poses a threat to health
or that requires treatment. However, because they may be short or
may not enter puberty when their classmates do, some may need extra
help coping with teasing or they may need reassurance that they
will go through full sexual development eventually. In a few normal
children who are very short or very late entering puberty, hormone
treatment may be helpful.
Growth Disorders
Diseases of the kidneys, heart, gastrointestinal tract, lungs,
bones, or other body systems may affect growth. Other symptoms or
physical signs in kids with these illnesses usually give clues as
to the disease causing the growth delay. However, poor growth can
be the first sign of a problem in some.
Growth disorders include:
Failure to thrive
, which isn't a specific growth disorder itself, but can be a
sign of an underlying condition causing growth problems. Although
it's common for newborns to lose a little weight in the first
few days, failure to thrive is a condition in which some infants
continue to show slower-than-expected weight gain and growth.
Usually caused by inadequate nutrition or a feeding problem,
it's most common in kids younger than age 3. It may also be a
symptom of another problem, such as an
infection
, a digestive problem, child neglect, or abuse.
Endocrinediseases
(diseases involving hormones, the chemical messengers of the body)
involve a deficiency or excess of hormones and can be responsible
for growth failure during childhood and adolescence.
Growth hormone deficiency
is a disorder that involves the pituitary gland (the small gland at
the base of the brain that secretes several hormones, including
growth hormone). A damaged or malfunctioning pituitary gland may
not produce enough hormones for normal growth.
Hypothyroidism
is a condition in which the thyroid gland fails to make enough
thyroid hormone, which is essential for normal bone growth.
Turner syndrome
, one of the most common
genetic
growth disorders, occurs in girls and is a syndrome in which
there's a missing or abnormal X chromosome. In addition to
short stature, girls with Turner syndrome usually don't undergo
normal sexual development because their ovaries (the sex organs
that produce eggs and female hormones) fail to mature and function
normally.
Diagnosing a Growth Disorder
The tests a doctor may recommend to detect a growth disorder
depend on the findings at each step of evaluation. A short child
who's healthy and growing at a normal rate may just be observed
throughout childhood, but a child who has stopped growing or is
growing more slowly than expected will often need additional
testing.
Your doctor or an endocrinologist will look for signs of the
many possible causes of short stature and growth failure. Blood
tests may be done to look for hormone and chromosome abnormalities
and to rule out other diseases associated with growth failure. A
bone age X-ray might be done and special scans (such as an
MRI
) can check the pituitary gland for abnormalities.
To measure the ability of the pituitary gland to produce growth
hormone, the doctor (usually a pediatric endocrinologist) may do a
growth hormone stimulation test. This involves giving the child
medications that cause the pituitary gland to secrete growth
hormone, then drawing several small blood samples over time to
check growth hormone levels.
Treating a Growth Disorder
Although the treatment of a growth problem usually isn't
urgent, earlier diagnosis and treatment of can help some kids catch
up with peers and increase their final height.
If an underlying medical condition is identified, specific
treatment may result in improved growth. Growth failure due to
hypothyroidism, for example, is usually treated with thyroid
hormone replacement pills.
Growth hormone injections for children with growth hormone
deficiency, Turner syndrome, and chronic kidney failure may help
kids reach a more normal height. Human growth hormone is generally
considered safe and effective, although full treatment may take
many years and not all kids will have a good response. And the
treatment can be costly (about $20,000 to $30,000 per year),
although many health insurance plans cover it.
What about growth hormone treatment for short children who
aren't growth hormone deficient when tested? The U.S. Food and
Drug Administration (FDA) has approved its use in such children if
they're predicted to reach a very short final height (under 4
feet 11 inches [150 centimeters] for a girl or 5 feet 4 inches [163
centimeters] for a boy).
Talk with your doctor for more information about treatment
options if you're concerned.
Helping Your Child
You can boost your child's
self-esteem
by providing positive reinforcement and emphasizing other
characteristics, like intelligence, personality, and talents. Try
to take the focus off of height as a measure of social
acceptance.
Kids who are very self-conscious about their size may need some
additional help in coping. In some cases, evaluation and treatment
by a mental health professional may be needed.
If You Suspect a Problem
If you're concerned about your child's growth, speak
with your doctor, who may refer you to a pediatric endocrinologist,
who can help diagnose and treat specific growth disorders.
It's also important to watch for the social and emotional
problems that kids with growth disorders face. It's not easy
being the shortest kid in the class and it's never any fun
being teased. Helping your child build self-esteem and emphasizing
strengths - regardless of how tall he or she may grow - might be
just what the doctor ordered.
Reviewed by:
Steven Dowshen, MD
Date reviewed: September 2008
Note: All information is for educational purposes only. For specific medical advice,
diagnoses, and treatment, consult your doctor.
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