Short Children Not Always Stunted, Hormonal Disorders Could Be the Cause

A senior paediatrician has reminded the public that a child’s height is not solely determined by hereditary factors and nutritional intake, as the growth process is an interaction of various factors, including the endocrine system which regulates growth hormone production. Professor Dr Aman Bhakti Pulungan, a paediatric endocrinology subspecialist, stated that normal child growth is a complex interaction between genetic, nutritional, socioeconomic, environmental, and hormonal factors. Therefore, a child’s growth cannot be attributed only to genetics or nutrition. “So it is not only determined by genetics or nutrition alone, but there are many influencing factors. For example, identical twins who share the same genetic material can end up with different adult heights,” Prof Aman said during a virtual discussion on Wednesday. He explained that in countries with four seasons, children’s growth patterns differ each season due to varying sun exposure. Psychosocial conditions can also affect growth, where children experiencing psychosocial stress are at risk of growth disorders. Additionally, exposure to cigarette smoke from parents can inhibit a child’s growth. Urbanisation is also often associated with better growth. Prof Aman cited the example of Vietnamese people who moved to the United States tending to have better height than previous generations. “If we look at Japan now, people are tall. Our grandparents might say Japanese people used to be short. But because of improvements in health services, nutritional intake, and other supporting factors, many Japanese people are now tall. This is also called a secular trend,” Prof Aman said. He also reminded parents not to immediately conclude that a short child is stunted. If a child’s weight is healthy while their height is not increasing according to age, the condition is not necessarily caused by malnutrition or stunting. “If the weight is okay, but the length or height is not increasing, then the child is short not because of stunting. Stunting must also be accompanied by a malnutrition factor,” Prof Aman said. Therefore, giving more milk or food to make a child taller is not always the solution. If the child’s nutritional status is already good, excessive intake can actually increase the risk of obesity. “If their nutrition is already fine, the child could become obese instead. That’s why it’s better to consult a paediatrician to find the cause,” Prof Aman said. He added that growth disorders in children can also be caused by hormonal factors. The endocrine system plays an important role in regulating growth through various hormones produced by the body. When a hormonal disorder occurs, a child’s height growth can slow down even if their nutritional needs are met. To determine whether a child’s growth is problematic, parents are advised to routinely monitor height and weight using growth curves. In Indonesia, the Indonesian Paediatric Society (IDAI) recommends using the WHO 2006 growth curve for children aged 0-5 years and the CDC 2000 curve for children over 5 years. These curves are differentiated by sex.