Growth in Children

Is your child growing alright?

Growth problems are very common but frequently missed. Schools, playgroups etc are unaware of the problems of dealing with very short child and your child may experience practical problems like unable to reach the peg or desk or sit on toilet. As they grow older they develop psychological problems of not being accepted by friends or treated as toy or picked up by other friends.

What is normal growth?

At birth child is around 50 cms. Growth is maximum in the first year of life, about 25 cm per year. It gradually declines from birth to about 4 years. During second year height gain is half of first year, around 12.5 cm and 6-7cm per year in third and fourth year of life. From fifth year till onset of puberty it is about 5 cm per year. During puberty girls gain 6-8 cm of height and boys grow about 7-10 cm.

How do I know if my child is growing okay?

Few clues for this are –

  • If your child is not outgrowing his /her clothes and / or shoes
  • If your child is among short ten children
  • If your child looks younger than his classmates
  • If your child has developed complex about height

What is a growth chart?

The best way of confirming normal / abnormal growth is by regular growth monitoring. This can be done by simple height measurement at regular interval of 3 months and plotting them on growth charts.

What are causes for short stature?

Most common cause for short stature is nutritional deficiency. Other causes are genetic or familial short stature, constitutional short stature or late bloomer, chronic diseases and hormonal deficiency. Among hormonal deficiencies they are thyroid and growth hormone (GH) deficiency. Rare causes are Turner syndrome, Intrauterine growth retardation and emotional deprivation.

What is Hypothyroidism?

Hypothyroidism means thyroid hormone deficiency. It can occur at any age from new born baby to old age. When a newborn baby develops hypothyroidism it is called congenital hypothyroidism. It is one of the preventable causes of mental retardation. Earlier the diagnosis and treatment better is the outcome. Earlier diagnosis has been achieved with the introduction of newborn screening for congenital hypothyroidism.

Symptoms of congenital hypothyroidism are prolonged jaundice, constipation, excessive sleep, poor feeding, large tongue hoarse voice, etc.

Symptoms in infancy and childhood are growth failure, constipation, dry skin, excessive sleep, etc.

What is IUGR ( Intrauterine growth retardation)?

Low birth weight or small for dates or babies weight is inappropriately low for duration of the pregnancy. This inappropriate low weight indicates that growth of the baby in womb has been unsatisfactory and this is why it is called intra uterine growth retardation or IUGR.

Is there treatment for short stature?

Yes, there is treatment for short stature. Initially good balanced diet with exercise, thyroid deficiency screening and treatment of chronic diseases are tried with regular growth monitoring. If all these factors are corrected and growth is not adequate then tests are done to rule out growth hormone deficiency. Growth hormone deficiency is treated with growth hormone.

What are the signs of GH deficiency?

Children with GH deficiency are short with normal body proportions and intelligence. Bone development may be delayed causing child to look younger than his actual age. There may be under development of mid facial structure and frontal bossing of the skull. They are often obese / overweight as GH controls fat deposition.

What is growth hormone deficiency?

Growth hormone is a hormone that regulates growth. GH deficiency occurs when pituitary gland (master gland, a small pea sized gland at the base of brain) fails to produce adequate amount of GH in the body.

How do you diagnose Growth hormone deficiency?

After all other possibilities of short stature have been ruled out, tests are done for growth hormone deficiency. First analyse growth rate in the growth chart, second, thorough physical examination, X-ray of hand and wrist to see bone development and compare it with height and chronological age. Confirmation is by giving the child a substance that releases growth hormone burst in normal children. If the release is sub optimal it confirms growth hormone deficiency.

Are there any side effects with the treatment?

No, there are no side effects with this, as it is developed by recombinant DNA technology but correct dose needs to be used.

What is the set back with Growth hormone?

COST. It is an expensive medicine. Hence it is not reachable by everybody. It needs to be given for a minimum period of one year and the cost increases if the child is older and heavier.

Why an adult cannot grow taller?

Adults cannot grow as their bones are fused. Once puberty is reached the sex hormones, oestrogens in girls and testosterone in boys cause fusion of bones. Once bones are fused we cannot grow any more.

This article is prepared by Dr Shaila SB
(Shaila@DiabetesEndocrinology.in)