Q & A Topic: Growth Disorders in Children
Q. What is the first step for parents who are concerned about their child’s growth?
A. It’s important for parents to realize that most short children do not have a serious growth problem. Many will grow at a normal rate and reach an adult height that is about the same as their parents’. But if parents have concerns about their child’s growth. they should speak to their doctor or healthcare practitioner. It’s most important to see how the child is growing and check the growth velocity. If the child has had regular checkups, the rate of growth can be easily evaluated; if there’s an unusual pattern of growth, a consultation with a pediatric endocrinologist should be considered.
Q. What steps are taken to evaluate a child with a growth problem?
A. The evaluation process starts with a medical history, exploring the child’s nutritional status, chronic illnesses and medicines, as well as a family history. There will also be a review of growth patterns for both the child and family members. A full physical examination is necessary, and if a growth problem is suspected, blood tests will be performed to look for evidence of systemic or hormonal issues. An x-ray of the hand is done to determine if the child’s bone development is on target for his or her age. A growth hormone stimulation test will be done if a Growth Hormone (GH) deficiency is suspected. A child who does have such a deficiency may be a candidate for Growth Hormone therapy.
Q. What is Growth Hormone?
A. Growth Hormone is a naturally occurring hormone secreted by the pituitary gland that is essential for body growth. GH levels rise progressively during childhood and peak during the growth spurt that occurs in puberty. After puberty, GH concentration decreases with age. In children with growth hormone deficiency, Growth Hormone therapy can stimulate tissue growth, improve body composition, and increase a child’s final adult height.
Q. What are the pros and cons of Growth Hormone therapy?
A. The pros are that a child can attain a target height that is within the normal range for the population, as well as for his or her family. GH can also improve body composition by increasing lean tissue mass and reducing the percentage of body fat. Studies have found that GH can also improve bone health. The cons of this therapy are the possibility of side effects such as injection-site reactions, headaches, scoliosis, and the possibility of an increased risk of developing type 2 diabetes. There have been concerns about GH leading to some types of cancer, but there is no scientific evidence to support that. The data from NCGGS in the U.S. and Canada has shown that the incidence of leukemia in GH-treated patients is comparable to that among the general population of age-matched children. However, patients who have a history of childhood cancer or a diagnosis that predisposes them to malignancy should be monitored closely.
Q. What should parents expect while their children are in treatment with GH?
A. During this therapy, a child needs to receive daily injections of GH, administered at home. The child will meet with a pediatric endocrinologist every three months to monitor growth velocity, have a physical exam, and complete laboratory tests to make sure the therapy is working. The duration of therapy depends on the child’s age at the beginning of treatment—the treatment is continued until the child has potential to grow and is responding to treatment.
Dr. Agarwal is a Board Certified Pediatric Endocrinologist. In addition to her private practice, she is an attending physician at The Children’s Hospital at Montefiore Medical Center. She has a particular interest in the effects of obesity and insulin resistance on cardiovascular health in children and adolescents, and holds the title of Expert Consultant, International Rett Syndrome Foundation.