What causes growth problems in children?

There may be a visible difference in growth between a child and their peers, whether it is being shorter or taller. If the difference is drastic enough, then parents may be concerned and may want to know if there is something that is causing it. Helping us to understand what these may be, leading consultant general paediatrician Dr Rajiv Goonetilleke explains more in this article.

What are the main issues in relation to child growth and development?

Issues around growth and development can worry parents. They consider whether a child is growing well, if the child is short compared to their peers or compared to their family, and sometimes they can be concerned that the child might be growing too fast or too tall compared to their peers or their family. These are the main reasons that parents would consider seeing a doctor regarding the growth of their child.

What causes growth problems in children?

In infancy (less than one), growth is driven mainly by nutrition. It drives growth throughout the growing years, but especially so in the first year. If an infant is not growing, it is more likely this is a nutritional issue; it is important to look at growth and nutrition in the first year.

In middle childhood (from the age of one until puberty), growth hormone deficiency is something that one needs to look at carefully amongst all the other illnesses. As opposed to infancy where a child can grow fastest at about 25cm per year, mid childhood is a more modest growth and can range from four centimetres per year to about six centimetres per year.

Then in puberty, growth is again very fast. Girls grow fastest in early puberty, having a growth spurt of about eight centimetres per year at peak, whereas boys grow fastest in mid puberty, with a growth spurt peak of about ten centimetres per year.

Each child needs to be looked at individually. Is it a nutritional issue, is it an illness that we can investigate, or is it just the fact these children are either genetically small because the parents are small or genetically tall because the parents are tall?

Is puberty delayed for any particular reason, or is puberty early?

If puberty is early, the young person might grow faster but finish earlier. However, if puberty occurs before those respective ages, it is considered early, and the young person may need investigations. These are the all the factors that one needs to look at in dealing with growth: either small stature, which is by far the most concerning for people, or, rarely, tall stature.

What are some of the main growth disorders?

The main illnesses that can impinge growth include:

• growth hormone deficiency
• coeliac disease
• renal failure
• thyroid disorders
• chromosomal problems (ie. Turner syndrome)

The vast majority of patients are concerned about small structure, but conversely, there can be worry about tall stature as well. This may well be due to constitutional reasons, where the parents are tall as well, although, there can be a few other conditions that need to be excluded, such as growth hormone excess, and chromosomal or genetic causes. 

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.