|How do I know my child is growing normally?
Normal growth is the increasing of both height and weight through cell division and growth. It depends on genetic background,hormone levels, and nutritional conditions etc.
Growth is divided into 4 steps
During infancy, children grow rapidly; then the rate of growth slows as they get older. But when puberty begins, the growth velocity accelerates again. After puberty ends, no further growth can be seen.
Before puberty, normal children grow over 5 cm a year. Children who grow less than 4cm a year should see a doctor for a proper diagnosis and treatment of short stature.
How do I know that my child has short stature ? Self-diagnosis for Short Stature
If you answer ‘yes’ to one of the 3 questions below, you have the possibility of having short stature or growth disorders. Therefore, you should get proper medical examinations
from a pediatric endocrinologist first.
1. Are you growing < 6 cm/year before 4 years?
Are you growing < 5 cm/year during 4-8 years?
Are you growing < 4 cm/year before puberty?
2. Are you more than 10cm shorter than your same age and gender group?
3. Are you one of the 3 shortest in your class?
Is height of a child always dependent upon the parents’ height?
The height does not always depend on parental height but, when one of the family members has short stature, their offspring might end up short for their age and gender, despite
growing at normal rates. Heredity is also one of the most common causes for short stature.
Treatment with growth hormone can increase growth development in this cause as well as other causes of short stature.
What factors are important in normal growth?
- Nutritional Deficiencies
- Precocious puberty: Onset of sexual Maturity occurring before 8 years in girls and 9 years in boys, are said to have precocious puberty.
- In long standing diseases like congenital heart disease, Kidney, liver and lung disease
- A baby with nutritional deficiency or affected by maternal infections during pregnancy has a tendency of much lower weight at birth,
which can continue into adulthood and results in short stature.
What is growth hormone?
Growth hormone is a protein hormone secreted by the pituitary gland that stimulates growth and cell reproduction. In the past, growth hormone was extracted from human pituitary glands. GH is now produced by recombinant DNA technology and is prescribed for a variety of reasons. As the hormone is now lab made it has become safer.
When can it be used?
- Growth Hormone Deficiency
- Small for Gestational Age
- Turner syndrome
- Chronic renal failure
- Prader-Willi syndrome
- Low birth weight children who remain short even at 2 years of age
- Idiopathic short stature (Short normal children) (ISS)
It has been reported that growth hormone treatment is the most effective before the onset of puberty.
Treatment of short stature should begin when children are in the lower grades of elementary school, well before the puberty begins ( The timing of onset of puberty in boys is around
11 years and is around 9 years in girls in the modern times).
What are it’s side effects?
Generally growth hormone is a safe medication. Side effects are unusual but reported. The most common side effects are reactions at the site of injection in the form of redness, mild headaches especially in the first few weeks, puffiness of face which all disappear after some days of treatment Some rare side effects are joint swelling, joint pain, carpal tunnel syndrome, benign intracranial hypertension, slipped capital femoral epiphyses and an increased risk of diabetes and may also produce an immune response against GH. Almost all side effects are temporary and reversible.
How long I have to give these injections for?
Growth hormone is found to be effective when it is administered over 2-3 years It is widely recommended that growth hormone be administered continuously before bone maturation until the onset of puberty. Especially, a long-term treatment is important for children with familial short stature.
How much growth can be expected with growth hormone treatment?
Average growth of children after 1 year of treatment usually ranges from 8-12 cm Growth hormone doubles the height velocity in the first year of therapy and continues to improve it at around 1.5 times the normal growth velcoty. Thus children get to grow more than 12 cm than predicted at pre-treatment provided that at least 2 years of therapy is completed. Children with familial short stature, which is the most common cause of short stature, will grow average 8cm a year during the 1st year of growth hormone treatment.
Do some exercises increase height and some reduce final height?
All exercises have a positive effects on health. There are no specific exercises that either improve of reduce the final height. Exercise keeps a child healthy and thus allow the child to reach a better growth potential.
10.What tests are generally asked for when my child is being investigated for short stature?
Checkups for Short Stature
The most important indicator of children’s growth is the growth velocity, not their current height. The growth velocity can be easily measured from each year’s physical examination data in school.
When an abnormal growth velocity is observed during recent 2-3 years, the child should get a medical evaluation by a pediatric endocrinologist. The medical evaluations recommended are numbered below, depending on the child’s physical conditions. With the test results, a doctor can find out the cause of short stature, current bone age, predicted adult height and need for treatment.
(1) Medical History of child & family
* Child: eating patterns, physical conditions at birth, and medical history from infancy to childhood.
* Family: sexual maturation, growth patterns, any medical history, eating habit and status during birth
(2) Physical Appearance
Child’s height, weight, body proportion, head circumference, and length of arms and legs etc.
(3) Bone Age
Radiography of hand and left wrist joints to measure bone maturation, which is closely related with child’s growth and sexual maturity.
(4) Blood Test (Hormone)
* Detection of growth hormone, thyroid hormone (thyroxin), sex hormones and adrenocortical hormone in blood, growth factors such as Insulin like growth fractor 1 (IGF -1)
* Growth hormone stimulation test, when it is suspected that child’s short stature is caused by growth hormone deficiency
(5) Chromosome Test
Karyotyping test for girls with short stature, who possibly have Turner syndrome After detail history & examination whatever hormone deficiency is suspected is investigated.
For this we do following tests:
Hormone test: Growth hormone stimulation test, thyroid (Free T4, Free T3, TSH), FSH, LH, testosterone, estradiol, IGF-1, IGFBP-3,etc.
Bio-chemical test: (Hb., ESR, GBP, Alkaline.Phosphatase, Calcium, Phosphorus, Urea, creatinine, Urine Protein, M/E ,Fasting urinary ph , Serum bicarbonate,Serum Potassium ,Serum protein, SGPT Stool Fat , Tests to diagnose other systemic diseases
Note: Not all tests are always needed. Based on the clinical features your physician will decide what tests are necessary.
How expensive is the growth hormone?
Treatment of children usually involves daily injections of growth hormone, usually for as long as the child is growing. Lifelong continuation may be recommended for those most severely deficient as adults. Most pediatric endocrinologistsmonitor growth and adjust dose every 3–4 months. Assessing the psychological value of treatment is difficult, but most children and families are enthusiastic once the physical benefits begin to be seen. Treatment costs vary by country and by size of child.