Diseases & Conditions
Any type of problem in children that prevents them from meeting realistic expectations of growth. Growth disorders may include FAILURE TO THRIVE in infancy, failure to gain height and weight in young children, and short stature or delayed sexual development in teens.
Shorter parents tend to have shorter children, which is a condition known as familial (or genetic) short stature; in this case, the short child does not have any symptoms of diseases that affect growth. Children with familial short stature still have growth spurts and enter puberty at normal ages, but they usually will only reach a height similar to that of their parents.
Children with constitutional growth delay are small for their ages but are growing at a normal rate. They usually have a delayed “bone age,” which means that their skeletal maturation is younger than their chronological age. (A child’s bone age is measured by taking an X ray of a child’s hand and wrist and comparing it to standard X-ray ﬁndings seen in children of the same age.) These children, who do not have any symptoms of diseases that affect growth, tend to reach puberty later than their classmates. On the other hand, these children tend to continue to grow until an older age, eventually catching up to their peers when they reach adult height. Often in these cases, one or both parents or other close relatives also experienced a similar delayed growth pattern.
Because children with familial short stature or constitutional growth delay often face social problems because they are short or lagging behind in sexual maturity, they may need help in coping with teasing.
Other Causes of Growth Disorders
Diseases of the kidneys, heart, gastrointestinal tract, or lungs also may lead to growth disorders, which may be the ﬁrst sign of a problem in some of these conditions. Endocrine diseases involving too little or too many hormones can cause growth failure during childhood and adolescence. Growth hormone deﬁciency is a disorder that involves the pituitary gland, which may not produce enough hormones for normal growth. Hypothyroidism is a condition in which the thyroid gland fails to make enough thyroid hormone, which is essential for normal bone growth.
One of the most common genetic growth problems is Turner syndrome, which occurs in girls when there is a missing or abnormal X chromosome. In addition to short stature, girls with Turner syndrome usually do not experience normal sexual development because their ovaries do not function normally.
A child who has stopped growing or is growing more slowly than expected will often need additional testing to uncover signs of the many possible causes of short stature and growth failure. These tests may include:
• Blood tests To look for hormone and chromosome abnormalities and eliminate other diseases
• Bone age X ray
• Brain scans To check the pituitary gland for abnormalities
• Growth hormone stimulation test To measure how well the pituitary gland produces growth hormone by giving medication to trigger the secretion of growth hormone, and then checking growth hormone levels
Treating a growth problem is usually not urgent, but early diagnosis and treatment of some conditions may help children achieve a more typical adult height. If an underlying medical condition is identiﬁed, speciﬁc treatment may improve growth. Growth failure due to hypothyroidism, for example, is usually simply treated by replacing thyroid hormones.
In addition, growth hormone injections for children with growth hormone deﬁciency, Turner syndrome, and chronic kidney failure may help them reach a more normal height. Human growth hormone is generally considered safe and effective, although full treatment may take many years and not all children will have a good response.