How to know if the child is short?
Short stature is not a disease; refers to children who do not meet the expectations of normal growth . The normal growth pattern is considered one of the most important parameters of the general well-being of the child. Parents’ concern about the possible consequences of abnormal stature is a frequent cause of medical consultation.
Measurement of the child’s height must be done properly. A single determination of height is much less useful than each child’s growth pattern over time. After measuring the child, the measurement obtained should be compared with that of other children of the same age and sex collected in growth charts. When the measured height is much lower than that which appears in the growth charts for the same age and sex (below the 5th percentile), we speak of short stature.
When using growth charts it should be noted that, in some cases, bone age (determined by X-ray) should be used instead of chronological age (the actual age of the child). Also in premature children it should be corrected for gestational age, at least during the first year.
- 1 What does it mean to be in the 5th percentile for height?
- 2 How does the growth rate vary?
- 3 Can height be predicted?
- 4 Is short stature a medical problem?
- 5 Is it necessary to perform diagnostic tests?
- 6 When to treat short stature?
- 7 Can growth hormone be used in children who are not deficient in it?
- 8 What are the disadvantages of growth hormone?
What does it mean to be in the 5th percentile for height?
Being in the 5th percentile for height means that, if we compare with 100 children of the same age and sex, only 5 would measure the same or less and 95 will measure more. Explained another way, if we put these 100 children in line from the shortest to the tallest, ours would be ranked number 5.
How does the growth rate vary?
Children usually grow rapidly in the first 2 years of life; then they grow at a relatively constant rate of about 5 to 7 cm per year until puberty and, during puberty, they grow a lot in a short time, this is what is called the pubertal spurt.
In some children who are in an intermediate percentile (50th percentile), their growth rate progressively slows until they reach the lowest percentiles during the first years of life. This downward trend, maintained for a minimum of one year, is a sign of alarm. These children should be monitored carefully, although they do not require further testing at this time. Evaluating children over time makes it possible to clarify whether the growth pattern is normal or abnormal.
Can height be predicted?
Final adult height depends on multiple factors that modify existing potential. There is no method that can accurately predict it. This must be taken into account when making decisions about the management of children with short stature. Among the most used methods to predict final height are:
- Parental height method. Although the contribution of genetics to final height cannot be measured, an estimate can be made based on the parental height adjusted for the child’s sex:
- Girls: 13 cm is subtracted from the father’s height and the arithmetic mean is made with the mother’s height.
- Children: 13 cm are added to the height of the mother and the arithmetic mean is made with the height of the father.
- Boys and girls: the final height can vary by 8.5 cm both above and below the values obtained previously.
- Methods that incorporate bone age. Bone age is determined by X-ray of the left hand and wrist, and represents the biological age of the child. The rate at which the skeleton grows does not always match the actual age. When the pediatrician doubts whether the growth is adequate or not, he usually requests a wrist X-ray to determine the bone age.
Is short stature a medical problem?
Short stature is not always a medical problem. Many healthy children are short:
- Idiopathic short stature. They are short children without any medical cause that can justify it. Its growth rate is in the low limit of normality. Its size at birth is usually normal, experiencing a delay around 3-6 months of age. The latest studies in this field suggest that there may be a genetic basis. Although the treatment of these children with growth hormone is controversial, the response to its administration is good, achieving increased growth. Within this group are:
- Familial short stature : One or both parents are short; When parents are short, their children are genetically more likely to be short. The growth pattern of a light-weight child with short stature and head circumference is generally associated with short family stature. They are children with normal bone age, but shorter than most of their peers.
- Constitutional growth retardation:Its size at birth is usually normal. They can grow at a slower rate than other children from the first months, or grow at a normal rate until 3 or 4 years old, slowing down from that moment on. Bone age is delayed. Due to this delay in bone age, growth can last longer than normal. Puberty is often delayed, and the time that elapses between the onset of puberty and the pubertal spurt is shorter, thus compensating for the greater number of years of growth. The final height is reached later and is usually normal, according to the family context. There may be a genetic basis since it is common for other members of the family with growth retardation.
- Early puberty. The pubertal stretch occurs earlier than expected. These children tend to grow up quickly before their time and have early sexual development. However, they are subsequently overtaken by their peers.
Short stature can be a medical problem if it is associated with:
- Kidney diseases Growth retardation in these children is due to multiple factors.
- Lung diseases. Severe asthma and cystic fibrosis can be associated with decreased growth.
- Serious cardiological diseases.
- Gastrointestinal diseases. The celiac disease and inflammatory bowel disease (especially Crohn ‘s disease) may be associated with decreased growth. Children with gastrointestinal failure are often lower in weight than in height due to malnutrition.
- Immunological diseases. The AIDS and syndrome combined immunodeficiency may be associated with decreased growth due to multiple factors.
- Cancer. Children with cancer can grow shortly before diagnosis due to poor diet and nausea and vomiting. After diagnosis, poor appetite, and nausea and vomiting induced by chemotherapy and radiation therapy, also contribute to growth retardation. After treatment, they can regain a normal growth rate. Cases that have received radiation therapy to the skull or thyroid may not regain a normal growth rate due to possible interference with the production of growth hormone and thyroid hormones, respectively.
- Metabolic and endocrinological diseases. They include deficiencies in growth hormone, thyroid hormones, adrenal and gonadal hormones, and vitamin D.
- Treatment with corticosteroids; corticosteroids slow growth acting at various levels. Its effects on growth may persist after the end of treatment.
- Genetic causes. Some chromosomal abnormalities such as Down syndrome, Noonan syndrome, Russell-Silver syndrome or Turner syndrome are associated with short stature.
- Intrauterine growth retardation. It can be due to multiple factors:
- Intrauterine infections.
- Maternal exposure to toxins, alcoholism or smoking.
- Maternal systemic diseases during pregnancy, such as pre-eclampsia.
- Skeletal disorders such as rickets or untreated hypothyroidism.
Is it necessary to perform diagnostic tests?
When the growth rate is below the 5th percentile for height for the corresponding age, the child should be studied. Your pediatrician may order a blood test and X-rays of both wrists.
When to treat short stature?
It depends on the cause of the short stature. In cases where short stature is due to a diagnosed disease that has treatment, by treating the disease the patient will grow. At other times, short stature cannot improve and is only one of the features of the disease. When the short stature is due to a disease with indication to treat with growth hormone, the treatment improves the adult height. Daily intramuscular injections are required for years. Children treated with growth hormone should have a follow-up that includes regular blood tests.
Can growth hormone be used in children who are not deficient in it?
In Spain, growth hormone is indicated for the treatment of diseases due to a deficiency of this hormone or for delays due to other causes for which its efficacy and safety have been demonstrated. The indications approved in Spain (financed by Social Security) are:
- Growth delays in children due to:
- Growth hormone deficiency.
- Turner syndrome.
- Prader-Willi syndrome.
- Chronic kidney disease
- Delayed intrauterine growth.
- Replacement therapy in adults with marked growth hormone deficiency.
- In the United States, it can also be used in adults for muscle loss due to HIV and short bowel syndrome.
There is the possibility of private financing (at the expense of the patient’s family) for cases that do not meet the previous criteria, in which the family wishes to try to improve adult stature, such as idiopathic short stature.
What are the disadvantages of growth hormone?
The side effects of growth hormone are few and can be corrected, although very long-term studies are needed for their perfect knowledge. At present it is better to speak of cost / benefit than risk / benefit since the administration of growth hormone is a very expensive treatment and the Public Health considers more important needs than to improve growth sometimes by less than 1 or 2 cm.