13 July 2015
Normal growth requires a child be healthy, well-nourished and loved. Hopefully, all children develop “normally” but sometimes, either due to nutrition deficits or genetics, certain children develop growth disorders.
The good news: Today there are excellent treatments and therapies to help reverse many growth disorders, such as short stature. Also, in many cases, growth disorders are temporary and a child eventually “catches up” to the heights of family members.
Pediatric growth charts help identify growth disorders early on
Pediatric growth charts are useful tools to assess growth. At a child’s annual physical, pediatricians plot the child’s height and weight sequentially over time on these growth charts. This allows for a comparison of the child’s growth to that of the general population.
In the first year of life, growth is largely dependent upon nutritional status. Although healthy nutrition is always important for normal growth, after the first year of life, genetics and hormones exert an important effect on growth as well.
By approximately 3 years of age, a child’s height percentile generally becomes apparent and the child should remain on that percentile until the onset of puberty. It is important to note that the height percentile of a child does not always correlate with the height percentile achieved as an adult. The timing of puberty (onset and duration) and the quality of the pubertal growth spurt have important roles in achieving adult height.
When to be concerned about your child’s growth
Your child’s growth should be evaluated if his/her height is less than or equal to the 3rd percentile, if the growth velocity is poor with a resultant deviation of your child’s height away from his/her normal percentile, or if your child’s height percentile is less than that expected for his/her genetic potential. If you are concerned about your child’s growth, it’s very important for you to check with your pediatrician to see if he/she feels your child’s lack of growth warrants an evaluation by a Pediatric Endocrinologist.
The role of a Pediatric Endocrinologist is to identify the cause of a child’s poor growth
A Pediatric Endocrinologist will ask for your child’s complete history (medical history and family history) and review his/her growth charts. Lab tests will be ordered and a bone age x-ray (an x-ray of the left hand which assesses the maturity of the child’s bones) will be obtained. An estimate of your child’s predicated adult height can be made by an assessment of his/her bone age.
If a medical condition is identified, your child may be given a referral to the appropriate physician for evaluation and possible therapy (e.g., if your child has abnormal testing for Celiac disease, he/she may be referred to a Pediatric Gastroenterologist for further testing and evaluation). Regardless of the diagnosis, the Endocrinologist may also recommend that your child’s growth continue to be monitored to confirm that appropriate growth ensues.
As human growth hormone is made by the body at night, growth hormone levels measured during the day are usually very low and are not a reliable indicator of growth hormone status. Certain children may require a Growth Hormone Stimulation Test (blood samples are drawn several times over the course of several hours) to determine if the child’s poor growth is the result of a deficiency of growth hormone.
The causes of short stature, a common growth disorder
The most common causes of short stature include both Familial Short Stature and Delayed Puberty (the “late bloomer”).
Familial short stature is characterized by a strong family history of short stature and the normal age of onset of puberty. A child’s predicted height should be in line with the heights of family members.
A child with delayed puberty may also be short as a child, but since puberty starts later than the average age, such a child will grow for a longer period of time, enabling him/her to achieve an adult height consistent with the heights of family members.
What to do if your child has a growth disorder
The role of a Pediatric Endocrinologist is to confirm whether or not your child is “healthy, well nourished and loved.” For certain children, growth hormone therapy may be medically indicated for the child to achieve normal growth and a normal adult height. Happily for a majority of children, this can certainly come to pass. Please come see us with more questions about raising a healthy child.
The more you know about growth disorders, the more you can help your child
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