Understanding child growth

In her latest online article, Professor Sze May Ng OBE gives us her insights into growth problems. She talks about what is normal growth, how to assess, the causes, treatment options, potential side effects and if growth problems in children can be prevented or managed through lifestyle and nutrition.

What is normal growth and how would one assess growth?

Normal growth is influenced by various factors, such as genetics, hormonal balance, chronic illnesses, bone disorders, nutrition, and emotional well-being. It varies among children and serves as a crucial indicator of overall health and nutritional status during infancy, childhood, and puberty.

In the UK and many other places, we gauge normal growth in terms of weight and height using percentile growth charts. These charts, particularly the WHO child growth standards, are accessible online and enable a comparison of a child's development—height, weight, and body mass index—with normative data for their age group.

For instance, a child on the 10th percentile for weight means he/she weigh less than 10 percent of children of the same age, while 90 percent weigh more. Conversely, a child on the 90th percentile for height indicates that 90 percent of same-aged children are shorter, while 10 percent are taller. Growth is typically monitored by schools and general practitioners, but a general paediatrician may step in if concerns arise, such as deviations from growth centiles.

Normal growth is most rapid from birth to around two to three years old, slowing down afterward. Another significant growth spurt occurs in early adolescence, coinciding with the onset of puberty. Assessing growth involves charting height and weight on appropriate centile charts, a thorough history to rule out chronic conditions or hormonal imbalances, a general health examination, and puberty staging, often performed by a specialist paediatric endocrinologist. Additionally, measuring the biological parents' heights and calculating their mid-parental height helps determine the genetic component of growth.

What causes growth problems?

Short stature or growth disorders can stem from various factors, including environmental, genetic, nutritional, and hormonal influences. Among these, familial factors play a significant role, meaning individuals often fall within the height percentiles of their short parents.

Conditions like constitutional growth delay of puberty can make someone appear short due to a delayed growth spurt. Additionally, chronic conditions such as renal, cardiac issues, cystic fibrosis, inflammatory bowel disease, coeliac disease, and malnutrition are crucial considerations. Being born small for gestational age, particularly in cases of extreme prematurity, may result in a lack of catch-up growth, contributing to short stature.

While growth hormone deficiency is a concern, it is relatively rare, affecting approximately one in four to five thousand individuals. Evaluating this deficiency isn't as straightforward as a simple blood test. Instead, it involves an endocrine stimulation dynamic test conducted over about three hours in a day case setting. This specialised assessment determines the individual's capacity to produce sufficient growth hormone for proper growth. As a result, diagnosing growth hormone deficiency requires consultation with a children’s hormone specialist (Paediatric Endocrinologist) and goes beyond routine blood tests.

What treatment options are available?

If the evaluation reveals growth hormone deficiency as your diagnosis, the next stage involves treatment, and the good news is that it is treatable. Treatment typically involves injections of synthetic growth hormone produced in a lab, which is identical to the growth hormone naturally produced by humans. Unlike before 1985 when growth hormone was extracted from pituitary glands, this modern approach eliminates any concerns associated with that process.

It's essential to understand that synthetic growth hormone has been used globally to treat over half a million children. The treatment requires careful evaluation, and once initiated, it involves regular injections. Monitoring and assessments are crucial aspects of the treatment process, and these are typically overseen by a paediatric endocrinologist to ensure its effectiveness. So, rest assured, the synthetic growth hormone used in this treatment is safe and mirrors the natural hormone your body produces.

What are the potential side effects of this treatment?

Regular assessments by a specialist paediatric endocrinologist play a crucial role in the growth hormone treatment process, typically scheduled every three to six months. It's important to be aware of potential side effects associated with growth hormone therapy, ranging from common issues like bleeding or allergies at injection sites to more infrequent occurrences, such as benign headaches. Uncommon side effects include benign intracranial hypertension, slipped upper femoral epiphysis, and a potential risk of diabetes in susceptible individuals.

Regardless of the specific side effects, monitoring is paramount once the evaluation is complete and treatment begins. This monitoring extends throughout the entire treatment period, covering the time from initiation until the child reaches their final adult height. Regular oversight ensures that any issues or concerns can be addressed promptly, contributing to the overall effectiveness and safety of the growth hormone treatment.

Can growth problems in children be prevented or managed through lifestyle and nutrition?

If growth hormone deficiency is not the underlying cause, maintaining a healthy lifestyle and proper nutrition becomes pivotal. I emphasised earlier the significance of a wholesome lifestyle because we are aware that disruptions in growth can result from factors like malnutrition. Conditions such as chronic kidney disease or cardiac issues can also contribute to short stature. While lifestyle changes may not prevent growth problems linked to hormone deficiencies, fostering a healthy lifestyle and ensuring good nutrition is a proactive step. By doing so, you increase the likelihood of achieving growth targets aligned with your parental growth centiles.

Professor Sze May Ng OBE is a distinguished consultant paediatric endocrinologist and consultant paediatrician. You can schedule an appointment with Professor Ng on her Top Doctors profile.