How is a child's growth assessed?
A one-time measurement says little: the doctor plots height and weight on centile graphs and looks at which curve the child is following and whether he changes it over time. The second key indicator is the growth rate in centimeters per year, for which there are age standards. The third guideline is target height, calculated based on the height of the parents: a child of short parents will naturally be short, and this is not a disease. It is not low growth in itself that is alarming, but a slowdown, a lag behind the parental forecast, or a sharp disproportion between height and weight.
- Evaluation using centile graphs over time
- Growth rate per year
- Calculation of target height based on parents' height
- Height to weight ratio
- Body proportions and signs of puberty
- Measurement using one method and preferably from one doctor
Common reasons
Most cases of short stature are not related to hormones. With familial short stature, the child grows at a normal speed, the bone age corresponds to the passport age, and the short stature repeats the parent’s. With constitutional retardation of growth and sexual development, the child lags behind his peers, enters puberty later, but grows longer and eventually reaches normal adult height - often one of the parents had the same story. A separate group consists of children born small at term and who have not caught up with their peers. Endocrine causes are less common, but they are the ones that require active treatment.
- Familial (genetic) short stature
- Constitutional delay in growth and sexual development
- Birth small for gestational age
- Chronic diseases of the heart, kidneys, lungs, intestines
- Celiac disease and malabsorption
- Insufficient or unbalanced nutrition
- Hypothyroidism
- Growth hormone deficiency
- Genetic syndromes, including Turner syndrome in girls
When to see a doctor
The reason for the examination is not only very low growth, but also any change in dynamics. If a child was among the average in height in the class, and in a year or two moved to the lowest, this is more important than the absolute number. The combination of short stature with excess weight should be alarming - for endocrine reasons, the child is often not thin, but vice versa. Girls with short stature and lack of sexual development require special attention: Turner syndrome must be excluded for them. Remember that growth plates close after puberty and growth cannot be affected later.
- Height is significantly below normal for age and gender
- Growth rate less than expected for age
- Moving to a lower centile curve
- Short stature and overweight
- Lack of sexual development in a teenager
- The lag is greater than the height of the parents allows
Survey
They begin with a careful measurement of growth dynamics, an assessment of body proportions and the stage of sexual development. X-ray of the hand determines bone age: if it lags behind the passport age, the child still has growth potential, which is typical for constitutional delay. Laboratory search is aimed at excluding chronic diseases and malabsorption disorders: general and biochemical blood tests, kidney and liver parameters, screening for celiac disease, TSH. If growth hormone deficiency is suspected, special stimulation tests are performed in a hospital setting, and girls with unexplained short stature undergo karyotyping.
- Accurate measurement of height and weight over time
- X-ray of the hand to determine bone age
- General and biochemical blood tests
- TSH and free T4
- Screening for celiac disease
- Karyotyping in girls
- Stimulation tests for growth hormone
- MRI of the pituitary gland with confirmed deficiency
Treatment and what really helps
They treat the cause, not the number. For hypothyroidism, replacement therapy is prescribed, for celiac disease - a gluten-free diet, for chronic diseases they are controlled, and growth is usually accelerated. Growth hormone therapy is used strictly according to indications - for confirmed deficiency and a number of conditions defined by clinical guidelines; it is carried out for a long time, under the supervision of a pediatric endocrinologist, with regular monitoring. For familial short stature and constitutional delay, treatment is not required; observation and explanation are sufficient. The basics are important: a good diet with enough protein, physical activity and sleep, since the bulk of growth hormone is released at night. Supplements “for growth” are useless without a doctor’s prescription.
- Treatment of the underlying disease
- Replacement therapy for hypothyroidism
- Gluten-free diet for celiac disease
- Growth hormone strictly according to indications
- A nutritious diet with sufficient protein
- Getting enough sleep at night
- Regular physical activity
- Refusal of dietary supplements “for growth”