Parents are reassured when their child is healthy and growing normally, but there may be times when they become concerned and wonder if their child is not growing as expected. They may compare their child to other children and notice that he is shorter than his peers.
It is important to speak to your child’s pediatrician if you have concerns regarding his growth. Doctors monitor a child’s growth using standing growth charts developed by the National Center for Health Statistics. Your pediatrician measures your child at every well-child visit and tracks his progress on the growth chart.
Parents should know there is a wide range of “normal” heights and weights. Children grow at different rates from infancy through childhood and adolescence. There are variations of normal growth patterns that are not associated with illness, such as genetics.
Children’s growth rate is the fastest in the first year of life, when they grow between seven to 10 inches. From 1 to 2 to years of age, children grow between four to five inches. After 3 years of age, they grow at two to 2.5 inches yearly until the time of puberty.
The onset of puberty differs for boys and girls and also has a range of “normal.” Girls will grow 2.5 to 4.5 inches yearly during puberty; boys will grow three to five inches yearly.
Parents may become concerned if the child is the shortest in the class, is growing less than expected yearly for his age, is unable to keep up with other children of the same age in sports or activities, or if the child shows early or delayed signs of sexual development.
Poor growth, a height and weight below the fifth percentile on the growth chart, or a decline to a lower percentile from a previously normal growth curve may be associated with serious medical conditions.
Your pediatrician will perform a detailed medical history including looking at birth history, diet, past illnesses, infections, and injuries. The pediatrician will also ask about family history, including heights of parents and other family members, chronic illness in the family, and any history of early or delayed puberty in family members.
A thorough physical examination will be performed to look for signs of poor growth. Laboratory tests may be done to evaluate for kidney, thyroid, liver, bone, and other disorders. X-rays, scans, or other specialized tests may be needed. Your pediatrician may refer you to a pediatric endocrinologist for further evaluation.
There are many causes for growth failure:
• Nutritional deficiencies or malnutrition.
• Systemic disorders, such as kidney, heart, lung, bone or liver disease; disorders of the digestive system.
• Endocrine disorders, such as hypothyroidism (low thyroid hormone); excessive cortisol production or exposure (Cushing Syndrome); growth hormone deficiency, insufficiency or resistance; diabetes.
• Congenital conditions, such as intrauterine growth retardation; prenatal infections; alcohol abuse during pregnancy; or other factors, such as genetic (chromosomal) or skeletal abnormalities.
• Idiopathic: no cause can be found.
Growth hormone deficiency is uncommon, but may occur at any age. It is diagnosed by performing special growth hormone tests to assess for growth hormone secretion, after excluding other conditions.
Specific FDA indications for growth hormone therapy include:
• Pediatric or adult growth hormone deficiency
• Turner Syndrome or SHOX Deficiency
• Prader Willi Syndrome
• Noonan syndrome
• Chronic renal disease
• Small for gestational age without a catch-up growth after 2 years of age
• Idiopathic short stature
Growth hormone treatment is NOT indicated in otherwise healthy children with short stature (i.e. those with familial or genetic short stature), or in children with Constitutional Delay of Growth and Puberty (a variation of a normal growth pattern).
As a parent, the most important thing you can do to keep your child healthy is provide proper nutrition, regular physical activity, a safe and nurturing environment, and have regular well-child check-ups with your child’s healthcare provider.
For more, visit: The American Academy of Pediatrics (www.aap.org), Centers for Disease Control and Prevention (www.cdc.gov), The Pediatric Endocrine Society (www.pedsendo.org), Human Growth Foundation (www.hgfound.org), or The Magic Foundation (www.magicfoundation.org).
