Common diseases that affect growth in children

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, delves into paediatric-related diseases and illnesses and how they differ from genetic causes for growth problems in children.

In relation to 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 going to be taller, and if the parents are smaller or shorter, it’s likely the child is going to be shorter. If the child is very small or tall compared to family and the centres on a growth chart, that’s something that needs to be considered in regards to the growth trend of the child. If the child is growing on their own path with their own centres on a growth chart, that is less worrying.

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?

In one case, it can be that there’s a genetic pattern for the child. An example, as mentioned before, if the parents are small, then the child is going to be small, and the same if the parents are tall. However, it can sometimes be what is called a constitutional delay in growth and puberty.

If one parent has had a late growth spurt or they were late in puberty, the child may experience the same. So, if the mother is late having her first period, it’s possible that the child might be late in going through puberty and development. 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 affect hormones, metabolism, and absorption. These may include:

• Thyroid levels: having hyperthyroidism or hypothyroidism
• Celiac 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, so a lack of nutrition might impinge growth. Hormones are important to drive growth and make a child grow at the correct speed or have the correct growth velocity. Diseases and illnesses that cause problems with these functions can cause growth problems, as well.

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 are called growth hormone provocation tests. There is usually serious concern 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 (ie. pubic hair is not appearing), there are things we can explore and investigate, and help if necessary. If it is due to a chromosomal problem (the way our genes are), there are tests that can be done to look for conditions. For example, girls who are especially small may need to consider a chromosome analysis for things like Turner syndrome where the chromosomes are not as they should be.

There are many things that need to be done, but the key is investigating if necessary or reassuring early rather than waiting until puberty has happened and finished. If puberty has already finished, then there is no intervention that can be done to make the child grow any more. Once puberty has finished, the growth plates in the long bones fuse, meaning that there is no possible growth; once girls have started their periods and once boys have started shaving, there is not much that can be done to enhance growth at those points.

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.