Growth Disorders
Growth depends on a complex range of factors, including genetic makeup, nutrition, and hormonal influences. Short height can be present for a wide range of reasons, including having parents with short stature, malnutrition, and certain genetic conditions.
If short stature results from growth hormone (GH) deficiency or other conditions, GH treatment can be used to boost growth. The younger the age of the child at which treatment starts, the better effect it will have on the child’s height.
How do I know if my child is short and needs to see a specialist?
Growth Charts for a population consist of percentile curves which are marked between the 3rd and the 97th percentile. The 50th percentile is the average and the 3rd and 97th percentile represent the lowest and highest limit of normal.
If you mark the height against the age of the child, and it is below the 3rd percentile (lowest Line), it means that your child is short.
Serial plotting of height measurements on a growth chart is also very important. If your child is crossing growth percentiles in the downward direction, it means that he is not growing well.
What is Short Stature?
The term Short Stature is used for a child who is below the 3rd percentile when marked on a growth chart for a given population.
When to suspect a growth problem in your child?
A growth problem is suspected if:
- Your baby is abnormally small at birth and has not shown rapid growth after birth
- Your child’s height is below the lower limit of normal on a growth chart
- The child’s height gain is less than 4 cm per year from the age of 6 years till the onset of puberty and less than 6-7cm/year during puberty.
- Your child is crossing percentiles on the growth chart in the downward direction, it means that your child may not be growing normally and needs to be evaluated.
If your child’s height has never been measured, a growth problem may be suspected if:
- Your child is one of the shortest in his/her class
- Your child’s growth over a year has been insignificant
- The child is not outgrowing his/her clothes
- His/her shoe size has not changed for a long time
How do I determine if my child is short because of the parents being short?
Your doctor will measure the height of the parents and calculate the expected height for your child. This is called the mid-parental or target height. Based on this there is a target range for the family.
If your child is short for the family, or not growing well then, a few tests will be done to decide the cause of the shortness.
How do I find out the cause of my child’s short height?
Short stature can be genetic, or it could be a manifestation of a disease. Your doctor will determine if your child’s height is normal for the family or if he is short. If the child is very short or not gaining adequate height, a series of tests will be done to see if the height is less due to some chronic disease, hypothyroidism, or genetic syndrome. Once all common causes of short stature are ruled out, your child’s growth may be observed for a few months or an evaluation for Growth Hormone Deficiency may be done.
Growth Hormone is a hormone that is essential for growth and a deficiency of this hormone will prevent your child from growing normally. In short girls, a blood test called karyotyping may be done to rule out a condition called Turner Syndrome, which is present from birth.
Some of the less common causes of short stature could be:
- Small for gestation (Birth weight <2.5 kgs of a full-term baby)
- Genetic defects- Syndromes (Prader Willi, Noonan, etc.) Skeletal Dysplasia
Your doctor may run some tests to rule out these uncommon conditions if a cause for short height is not found.
How do we test for Growth Hormone Deficiency?
Growth Hormone is a hormone that is secreted by a small gland in the brain called the pituitary gland. It causes an increase in growth through 2 other hormones called the IGF-1 and IGFBP-3.
Growth hormone is secreted in pulses at night during sleep, so a normal child can have a low level if tested.
Growth hormone is secreted in pulses at night during sleep, so a normal child can have a low level if tested. Hence a stimulation test is done to make a diagnosis of growth hormone deficiency. A medicine is given to the child to increase the level of growth hormone and then a small amount of blood is taken every 30 minutes up to 90-120 minutes. The level of growth hormone is measured in all the samples, and if it is less than 10ng/ml, it means that your child may be growth hormone deficient. Along with the stimulation test, the IGF-1 and IGFBP-3 levels are also tested to confirm the diagnosis.
What kind of treatment is given to short children?
All short children may not need to be treated.
If an underlying disease is found, the cause needs to be treated, and the child will grow normally
Growth Hormone has been tested for multiple causes of short stature but has been found to be beneficial in increasing the final height only in the following conditions:
- Growth Hormone Deficiency
- Turner Syndrome
- SHOX deficiency
- Chronic Renal Failure
- Small for gestation
- Prader-Willi Syndrome
- Idiopathic short stature
When should a person visit the doctor?
You should visit your doctor or a Pediatric Endocrinologist whenever you observe that your child is short or not gaining height normally. The doctor also needs an observation period to see if the child is growing well and if any intervention is needed, the younger the child, the better the response to treatment. If one keeps waiting till puberty hoping that the child will grow on his own, very often it is too late to improve the child’s height.
