Parents often worry about their child's growth and development. As children grow at different rates, it can sometimes be difficult to know whether they’re growing sufficiently.
We spoke with Dr Rajiv Goonetilleke, a general paediatrician and an expert in paediatric endocrinology. He let us know how a child's growth should be evaluated, some of the main causes of growth delay in children and how they're diagnosed.
What are the causes of growth delay in children?
We have to look at the family, are they short because their family is? If your family is small you’re likely to be small also. Also, we’d look at race and ethnicity.
Causes of growth delay in children can be multifactorial. It’s often related to the parents’ height and the mid parental height is a rough indicator of the child’s target height. There are ethnic variations as well. When a child or young person presents with small stature, the first thing to do is obtain a good history.
Questions we should answer about the patient:
- What was the birthweight?
- Is this something noticed recently or have they ‘always’ been small?
- Has there been any pubertal changes?
- Are there any other symptoms like abdominal pain, constipation or headaches?
They may be having a hard time at school due to being small. Often it’s just that they are late developers. This is known as constitutional delay in growth and puberty, this will be a normal variation and they will eventually be of a height appropriate for her family and ethnicity.
Often there is a family history of one or both parents having a similar problem.
Less commonly there can be medical problems
These include true growth hormone deficiency, and medical conditions like coeliac disease, hypothyroidism and rarely undiagnosed chronic renal failure and inflammatory bowel diseases, especially Crohn’s.
There can be genetic conditions including Turner syndrome and Turner mosaic in girls. Do they fit into the family target, if they don’t then we’d have to look at the history, was the child born very small, a normal size in height and weight or is he going off.
What’s the trend of growth?
If they are small it would be important to compare their height with their age. If a young person in mid puberty is not growing appropriately it may be much more serious. Growth rates in mid childhood can be between 4.5-6 cm per year but in mid puberty young people can grow 8-10 cm per year.
Therefore, if a young person is measured over time (six months apart at least) and their growth is slow, one would have more concern. If someone is in mid puberty and growing only 4cm a year, that would be more concerning than if they were a child. Lack of growth, could either be due to genetics or something pathological. Ultimately, lack of growth may be related to ‘constitutional delay of growth and puberty’ (CDGP), that’s where everything is fine but they will eventually catch up.
How are growth problems in children diagnosed?
Baseline investigations would include blood tests to test renal function, thyroid function, check for coeliac disease, Inflammatory markers such as an ESR, and an IFF-1 (indirect measure of growth hormone).
An X-ray of the left hand and wrist to assess bone maturity, also genetic blood tests for chromosomes and/or microarray may be needed.
Growth hormone is secreted in pulses from the anterior pituitary, therefore measuring a one-off growth hormone level is not useful. If needed we have to do a dynamic growth hormone test like an insulin tolerance test.
What medications are used to treat growth failure in children?
Treatment wise it depends on the cause. If it's coeliac disease, you can treat the lack of growth with growth hormone.
What is the prognosis for growth failure in children?
Most cases of delayed growth in children can be resolved with appropriate treatment.