We know that there are a variety of things that can have an effect on growth in children. Whether it be nutrition, genetics, hormones, or a condition, intervention may be needed if it is serious enough. In this article, expert consultant general paediatrician, Dr Rajiv Goonetilleke, goes into diseases and illnesses and how they differ from genetic causes for growth problems in children.
What aspects of growth are taken into consideration?
There are a few aspects of growth that need to be looked at and screened. The first questions that need to be asked are: Is the child growing at a normal pace, at a normal speed? Is the child actually slowing down in the speed of growth? Is the child crossing centres on a growth chart?
The second questions that will be asked include: Is the child small or short compared to the family? Is the child small but is actually relevant for the family’s height, or is the child small compared to the parents?
If parents are tall, it is likely that the child is likely to be taller, and if the parents are smaller or shorter, it’s likely the child is likely to be shorter. If the child is very small or tall compared to family centiles on a growth chart it may be significant.
Especially in the first year of life, adequate nutrition is important as it drives growth and continues to do so throughout life. This and other common factors that can impinge on growth are considered during screening.
How much can genetics affect growth?
Children who have tall parents are more likely to be taller and vice versa. However, some children can have constitutional delay in growth and puberty. If one parent, or sometimes both, has had a late growth spurt or they were late in puberty, the child may experience the same. Therefore, if the mother is late having her first period, it’s possible that the child might be late in going through puberty and development. This may then cause short stature relative to their peers at school. It is a normal phenomenon, and these children will eventually get back to normal height and what would be appropriate for their family target height.
What diseases or illnesses can affect growth in children?
Some common diseases or illnesses that can also make a child not grow could be due to issues with hormones, metabolism, and absorption. These may include:
- Thyroid levels: having hyperthyroidism or hypothyroidism
- Coeliac disease: an intolerance to gluten in wheat can be associated with tummy pain, constipation, or loose stools
- Renal failure (rarely): chronic renal failure can cause hormone deficiency
Nutrition absorption is important, therefore a lack of nutrition might impinge on growth. Hormones are important to drive growth and make a child grow at the correct speed or have the correct growth velocity.
How can a problem with growth be tested?
A one-off blood test doesn’t allow formal growth hormone testing. Rather, we can do what is called IGF-1, or insulin-like growth factor 1. This gives doctors an idea if the growth hormone is adequate.
If there is serious concern about growth hormone deficiency, then there are initial screening tests that need to be done. Even further, there are other tests that will need to be done which involve what are called growth hormone provocation tests. Serious concern is usually if a child is small compared to their parents, if a child’s speed of growth is slowing down, or if the child is extremely small compared to parents and peers.
If a child has a genuine problem entering puberty, investigations may be needed. These may include blood tests and an X-ray to look at bone maturity in the first instance.
If you are concerned with your child’s growth or would like more information, you can schedule a consultation with Dr Rajiv Goonetilleke on his Top Doctors profile.