The term growth disorder is used to describe the abnormal development of a child, meaning that the child develops either faster or slower than other children of the same age. Measuring the annual growth rate is particularly useful in the diagnosis of such disorders.
Growth Disorders and the Growth Curve
Normal growth is based on child development curves that indicate whether height, weight, and body mass index are within the normal range. The percentile (3, 10, 25, 50 etc.) is indicated at the end of each curve. For example, when a child is in the 50th percentile, half the children are taller and half shorter that he or she is.
The largest number of children with a normal growth rate fall between the 3rd and 97th percentile. Children under the 3rd or over the 97th percentile have growth disorders.
Growth Disorders: Short stature
Children under the 3rd percentile on the growth curve fall into the short stature category. Assuming that children over the age of three grow approximately 5 cm per year, it is possible to differentiate between a child who is growing slower than others and one who is simply petite.
Growth Disorders: Causes of short stature
Genetic factors are the most common causes of short stature. Familial or genetic short stature refers to children whose parents are also short. These children are under the 3rd percentile, but have a normal growth rate. They enter puberty normally and their final height is normal and proportionate to their genetic potential. Another cause of low stature is constitutional delay (normal children who are small for their age but have a normal growth rate). In this case, the children are under the 3rd percentile and their growth rate is marginally normal. They enter late into puberty and their final height is determined by hereditary factors.
Short stature may also be due to pathological causes that slow down the child’s growth rate, including:
- Skeletal malformations (achondroplasia)
- Dysmorphic syndromes (Prader-Willi Syndrome)
- Genetic disorders (Down Syndrome, Turner Syndrome)
- Gastrointestinal diseases (celiac disease, inflammatory bowel disease)
- Endocrine disorders (hypothyroidism, growth hormone deficiency, Cushing’s Syndrome)
- Chronic diseases (kidney disease)
- Intrauterine growth restriction (IUGR).
Growth Disorders: Diagnosing short stature
The doctor will take a complete family and individual history, followed by a clinical examination and tests, including:
- Haematological and biochemical screening
- Hormone panel
- Hand and wrist x-ray to determine bone age
- Haematological and imaging of the pituitary gland
- Specific tests to identify growth hormone levels, growth hormone stimulation test (glucagon, clonidine, propranolol, l-dopa).
Growth Disorders: Treatment of short stature
Treatment of short stature will depend on the cause of the disorder, as well as the age and general health of the child. The doctor will regularly monitor the child to assess his or her growth rate. For example, in the case of hypothyroidism, levothyroxine is administered; in the case of growth hormone deficiency, the hormone is administered, while children with skeletal malformations require surgical intervention.
Growth Disorders: Tall stature
Children over the 97th percentile fall into the tall stature category. Usually, when a child (especially a boy) is taller than the rest of the children his or her age, parents are not concerned – except in the case of a very tall girl.
Growth Disorders: Causes of tall stature
Early puberty causes an increase in the child’s growth rate and bone age. Children with early puberty are initially tall, but their final height may be short. Tall stature in families is another category, which involves tall parents. The growth rate of these children is normal, as is the onset of puberty, and their final height is proportional to their genetic background.
Tall stature may also be due to:
- Chromosomal abnormalities (Klinefelter’s Syndrome, homocystinuria)
- Genetic disorders (Sotos Syndrome or Marfan Syndrome)
- Hyper-secretion of the growth hormone
- Endocrine disorders (hyperthyroidism)
Growth Disorders: Diagnosing tall stature
Diagnosis is based on the medical history of the child and the parents, the stage of puberty and the characteristics of each syndrome. The following tests are required:
- Haematological and hormone screening
- Hand and wrist x-ray to determine bone age
- Imaging of the pituitary gland
- Growth hormone levels.
Growth Disorders: Treatment of tall stature
Treatment of tall stature will depend on the cause of the disorder. For example, when due to early puberty or hyperthyroidism, it can be treated with medication.
Growth Disorders: What role does nutrition play?
The maximum height that a child can reach is primarily determined by genetic and environmental factors and, of course, by the general health of the child. However, nutrition plays a very important role. A balanced diet, with foods rich in protein, fruit, vegetables and dairy products, combined with exercise and quality sleep positively affects the development of children.