Identifying when your children experience delayed growth

Donya Betancourt, Pediatrician, Sanur, Bali, drdonya@hotmail.com

Determining if your child is experiencing delayed growth is not that easy. But if the majority of your answers to the following questions are yes, see your child's doctor and discuss the issue.

* Is my child shortest or tallest in the class?

* Is my child still wearing last year's clothes or outgrowing clothes much faster than usual?

* Is my child unable to keep up with other children of the same age in play?

* Is my child growing less than 2 inches (5 cm) or more than 3 inches (7.5 cm) a year?

* Is my child complaining about his or her size?

* Is my child showing signs of early sexual development, before age 7 in girls and before age 9 in boys?

* Has my 13-year-old girl or 15-year-old boy failed to show any signs of sexual development?

In this article, part two a of three-part series of articles on child growth, let's start with short stature.

Short stature is a relative term used when referring to any person that is more than two standard deviations below the average height for a person of the same age and sex.

Short stature is separated into two different categories. One is disproportionate short stature (short trunk and short limbs), such as achondroplasia or bone dysplasia.

Another one is proportionate short stature, whereby the child is like others -- except short. This is more common. Some children are short because they inherit the body makeup of their parents; called familial short stature.

Next is constitutional growth delay with delayed adolescence or delayed maturation. Typically, children with constitutional growth delay have been behind their peers in height since very early in childhood, but have continued to grow at a slow to normal rate. They will enter puberty two, three or even four years later than other children their age, but will have a normal growth spurt and end up about as tall as their parents.

A more uncommon cause is growth hormone deficiency (GHD), it may occur at any time during infancy or childhood. There are many causes of GHD, most of them involve damage to the pituitary gland or a specialized part of the brain that controls the pituitary. A major sign of GHD is a marked slowing of growth, usually less than 2 inches (5 cm) a year.

Many children with GHD have normal body proportions and normal intelligence, although some may be overweight for their height or have problems with low blood sugar levels. GHD is diagnosed through special blood tests which look for growth hormones in the blood.

Then, there is thyroid hormone deficiency, which affects the child from the time of birth. Characteristics are short, prolonged jaundice and an inactive child. The condition can be treated with hormone replacement therapy depending on which one is deficient.

If you suspect a problem with your child's growth, visit the doctor. Your doctor will ask questions about family history, illness and nutrition, and examine the child's physical height and weight. If the doctor suspects short stature, an examination will be conducted, comprising X-rays or scans to check on the condition of the pituitary gland. Blood tests and examinations of the kidneys, bones and thyroid gland. The level of hormones in the blood may be checked. An X-ray of the child's hand and wrist may be made to check the child's bone age. In some short children, the maturity of the bones lags behind the child's actual age. The bone age may be delayed for a variety of reasons, X-rays are very useful in determining the growth potential of a short child.

Treatment for short stature depends on the cause, using hormones in case of hormone deficiency or reassurance in the case of familial short or delayed growth and puberty. It is a good idea to keep records of height and weight from routine examinations, you may find it helpful to maintain your own records of the child's height and weight.

As I mentioned last week, parents are usually more concerned about short stature rather than tall stature and most of the time the parents concern is unwarranted and the child grows to a normal height. Next week we will find out what causes tall stature.