Dr. Tariq Jagnarine
Fam Medicine, Endocrinology/ Diabetes
A growth delay occurs when a child isn’t growing at the normal rate for their age. The delay may be caused by an underlying health condition, such as growth hormone deficiency or hypothyroidism. In some cases, early treatment can help a child reach a normal or near-normal height.
CAUSES OF DELAYED GROWTH
Delayed growth can have a wide variety of causes. The most common causes include:
* A family history of short stature
If parents or other family members have short stature, it’s common for a child to grow at a slower rate than their peers. Delayed growth due to family history isn’t an indication of an underlying problem. The child may be shorter than average simply because of genetics.
* Constitutional growth delay
Children with this condition are shorter than average but grow at a normal rate. They usually have a delayed “bone age,” meaning their bones mature at a slower rate than their age. They also tend to reach puberty later than their peers. This leads to a below-average height in the early teenage years, but they tend to catch up with their peers in adulthood.
* Growth hormone deficiency
Under normal circumstances, GH promotes the growth of body tissues. Children with a partial or complete GH deficiency won’t be able to sustain a healthy rate of growth.
* Hypothyroidism
Babies or children with hypothyroidism have an underactive thyroid gland. The thyroid is responsible for releasing hormones that promote normal growth, so delayed growth is a possible sign of an underactive thyroid.
* Turner syndrome
Turner syndrome (TS) is a genetic condition that affects females who are missing a part or all of one X chromosome. TS affects approximately 1 in 2,500 females. While children with TS produce normal amounts of GH, their bodies don’t use it effectively.
Less common causes of delayed growth include:
* Down syndrome, a genetic condition in which individuals have 47 chromosomes instead of the usual 46.
* Skeletal dysplasia, a group of conditions that cause problems with bone growth.
* Certain types of anemia, such as sickle cell anemia
* Kidney, heart, digestive, or lung diseases
* Use of certain drugs by the birth mother during pregnancy
* Poor nutrition
* Severe stress
SYMPTOMS ASSOCIATED WITH DELAYED GROWTH
If a child is smaller than other children their age, they may have a growth problem. It’s typically considered a medical issue if they’re smaller than 95 percent of children their age, and their rate of growth is slow.
A growth delay may also be diagnosed in a child whose height is in the normal range, but whose rate of growth has slowed. Depending on the underlying cause of their growth delay, they may have other symptoms:
* If they have certain forms of dwarfism, the size of their arms or legs may be out of normal proportion to their torso.
* If they have low levels of the hormone thyroxine, they may have a loss of energy, constipation, dry skin, dry hair, and trouble staying warm.
* If they have low levels of growth hormone (GH), it can affect the growth of their face, causing them to look abnormally young.
* If their delayed growth is caused by stomach or bowel disease, they may have blood in their stool, diarrhea, constipation, vomiting, or nausea.
DIAGNOSIS OF DELAYED GROWTH
A doctor will start by taking a detailed medical history. They’ll collect information about the child’s personal and family health history, including:
* Birth mother’s pregnancy
* Child’s length and weight at birth
* Heights of other people in their family
* Information about other family members who have experienced growth delays.
The doctor may also chart the child’s growth for six months or more.
Certain tests and imaging studies can also help the doctor develop a diagnosis. A hand and wrist X-ray can provide important information about a child’s bone development about their age. Blood tests can identify problems with hormone imbalances or help detect certain diseases of the stomach, bowel, kidney, or bones.
In some cases, the doctor may ask a child to stay overnight in the hospital for blood testing. This is because about two-thirds of GH production happens while a child sleeps.
Also, delayed growth and small stature may sometimes be an expected part of a syndrome that the child has already been diagnosed with, such as Down syndrome or TS.
TREATMENT FOR DELAYED GROWTH
A child’s treatment plan will depend on the cause of their delayed growth. For delayed growth associated with a family history or constitutional delay, doctors don’t usually recommend any treatments or interventions.
For other underlying causes, the following treatments or interventions may help them start growing normally.
* Growth hormone deficiency
If a child is diagnosed with a GH deficiency, their doctor may recommend giving them GH injections. The injections can usually be done at home by a parent, typically once a day.
This treatment will likely continue for several years as the child continues to grow. The child’s doctor will monitor the effectiveness of the GH treatment and adjust the dosage accordingly.
* Hypothyroidism
A child’s doctor may prescribe thyroid hormone replacement drugs to compensate for a child’s underactive thyroid gland. During treatment, the doctor will watch a child’s thyroid hormone levels regularly. Some children naturally outgrow the disorder within a few years, but others may need to continue treatment for the rest of their lives.
* Turner syndrome
Even though children with TS produce GH naturally, their bodies can use it more effectively when it’s administered through injections. Around age four to six, a child’s doctor may recommend starting daily GH injections to increase their likelihood of reaching normal adult height.
Like the treatment for GH deficiency, usually giving injections to the child at home. If the injections don’t manage the child’s symptoms, the doctor can adjust the dosage.
There are more possible underlying causes than the ones listed above. Depending on the cause, there may be other available treatments for the child’s delayed growth. For more information, talk to a doctor about how to help a child reach normal adult height.
PROGNOSIS
A child’s outlook will depend on the cause of their growth delay and when they begin treatment. If their condition is diagnosed and treated early, they may reach normal or near-normal height.
Waiting too long to start treatment can raise their risk of short stature and other complications. Once the growth plates at the end of their bones have closed in young adulthood, they won’t experience any further growth.
Ask the child’s doctor for more information about their specific condition, treatment plan, and outlook. They can help the child’s chances of reaching a normal height, as well as their risk of potential complications.
