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Growth Problems

What are growth problems?

A child's growth and development can be influenced by:

  • genetics

  • eating habits and nutrition

  • sleeping patterns

  • endocrine function (hormones)

  • presence or absence of chronic illness

Each child grows at a different pace. Try not to compare your child’s growth with children of the same age. Every parent needs to regularly monitor their child’s growth. This can be done with the help of growth charts and the child’s doctor.

If a child’s growth is not monitored closely, growth disorders may be missed. A growth disorder prevents the child from reaching the optimum height and weight. It can influence other aspects of the child’s mental, physical, or emotional development.

Types of growth disorders

Failure to thrive

Failure to thrive is not a growth disorder. It is a label given to children whose weight or rate of weight gain is significantly lower than other children of the same age and gender.

Failure to thrive can be caused by many factors:

  • feeding problems
  • illness, poverty
  • malnutrition
  • poor interaction between parent and child

Regardless of its cause, all children who are failing to thrive are at risk for slow or stalled growth.

Short stature

“Short stature” is also a descriptive label. It is not a growth disorder. It refers to children whose height or rate of height gain is lower than other children of the same age and gender.

Short stature can have some of the same causes as failure to thrive. More commonly, it is associated with genetics and not disease. Some children grow more slowly but stop growing at a later age and so they reach normal heights. Other children simply inherit a parent’s final height.

Children with short stature may not eat as much as you would like because they do not need to until they have a growth spurt. Pressuring children to eat more may make them gain weight but not height.

Endocrine diseases

The endocrine system is the body’s chemical messenger system. It transports hormones throughout the body. The hormones help regulate processes in the body, including growth. When there is a disorder with the endocrine system, growth can be stunted.

Endocrine disorders include:

  • Growth hormone deficiency: This rare disease happens when a child has little or no growth hormone. Growth hormone is made by the pituitary gland. Growth hormone stimulates growth through chemical interactions in the body. Without it, or without enough of it, growth is slowed or stunted completely.

  • Hypothyroidism: This is a condition caused by low levels of thyroid hormone in the blood. Without enough of this hormone, babies can suffer from poor brain development. Older children can have slow growth and slow metabolism.

Turner syndrome

Short stature is found in girls with Turner syndrome. Turner syndrome is when a girl is born with a missing or damaged X chromosome. Girls with Turner syndrome are not able to reproduce because their ovaries do not develop properly. They may also show other physical signs.

Signs and symptoms of growth problems

A baby’s or child’s growth problem can be noted after measurements of length or height show a slower than normal rate of growth.

Other causes of growth problems

Disturbances in health and nutrition almost always affect growth.

Other causes of growth problems include:

  • serious conditions of the brain, heart, kidneys, or lungs

  • inflammatory bowel disease

  • chromosomal abnormalities such as Down syndrome

  • Cushing syndrome (abnormally high cortisol levels)

  • rare genetic syndromes

How a doctor can help your child

Your child’s doctor can help by regularly monitoring your child’s growth. Proper growth assessment and monitoring includes:

  • recumbent (lying down) length from birth to 2 or 3 years of age

  • standing height for children who are able to stand

  • weight

  • head circumference until 2 years of age

Using the weight assessment alone is not helpful. This is because it cannot distinguish a tall, skinny child from an obese or well-proportioned one.

A child who has stopped growing or is growing slowly may need additional testing to determine the cause. Once failure to thrive has been ruled out, the doctor may refer your child to an endocrinologist. This specialist will look for possible causes of the growth failure. Blood tests, X-rays, and body or brain scans may help determine the cause of the growth failure.

Treatment

If a specific disease has been determined, certain treatment options may be available to increase the child’s final height. Growth problems due to endocrine disorders like hypothyroidism may be treated with thyroid replacement pills. Growth hormone injections may be provided to children with a growth hormone deficiency or Turner syndrome.

What you can do to help your child with growth problems

Have your child weighed and measured at each of these times:

  • within 1 to 2 weeks of birth

  • at 1, 2, 4, 6, 9, 12, 18, and 24 months

  • once a year between 4 and 6 years

Older children and teenagers should also be measured once each year.

Once a child has been diagnosed with a growth problem, it is important to stress the child’s other characteristics like musical ability or love of reading. Parents need to help build up their child’s self-esteem and self-confidence. A growing sense of self-worth can develop from skills and activities. It may also be important to discuss with your child the best ways to react to peers who may comment on this short stature.

When to see a doctor

All parents should be seeing their child’s doctor regularly, but if you discover a sign or symptom that concerns you, see the doctor immediately.

Key points

  • A child’s growth needs to be regularly monitored. This can be done with the help of growth charts and the child’s doctor.

  • Poor feeding sessions or illness can lead to a slow growth, but this may not be a growth disorder.

  • A growth disorder may be present at birth or acquired later.

  • Growth disorders may or may not be treated with medication.

Mark Feldman, MD, FRCPC

3/5/2010

A health professional’s guide to using growth charts. Paediatr Child Health 2004;9(3):174-6 Revision in progress February 2009: http://www.cps.ca/english/statements/n/nutritionnotegrowth.htm 

“Assessing and Monitoring Growth in Canadian Infants and Children: Which Growth Charts to Use? A Collaborative Statement from Dietitians of Canada, Canadian Paediatric Society, The College of Family Physicians of Canada and Community Health Nurses Association of Canada, 2003”. http://www.dietitians.ca/news/downloads/position_growth_charts_children_March2004.pdf.  Last accessed Dec 2009.

“Is my child growing well?” Questions and answers for parents: http://www.caringforkids.cps.ca/growing&learning/Growth.htm

Rudolph, Colin (editor). Rudolph's Pediatrics. Chapter 24.2 Disorders of the anterior pituitary gland, hypothalamus, and growth. Edward O. Reiter A. Joseph D'Ercole Part of "Chapter 24 - The Endocrine System" New York : McGraw-Hill, Medical Pub. Division, 2003.  

Rudolph, Colin (editor). Rudolph's Pediatrics. Chapter 1.1 Physical Growth. New York : McGraw-Hill, Medical Pub. Division, 2003.  





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