Growth Problems in Children

A growth problem means that a child falls either below or above the average range of growth for a child's age, sex, family history, or racial background.

Growth disorders can have many causes. They usually fall into 1 of the following groups:

• Familial short stature. A child's height is part of their family's pattern of inherited short height.

• Familial tall stature. A child's height is part of their family's pattern of inherited tall height.

• Constitutional delay of growth and pubertal development. A child tends to be shorter than average and enters puberty later than average, while growing at a normal rate. This may be inherited. These children tend to catch up in time and reach their normal adult height.

• Illnesses that affect the whole body (systemic diseases). This includes ongoing malnutrition, digestive tract diseases, kidney disease, heart disease, lung disease, diabetes, or chronic severe stress. Any of these conditions can cause growth problems. So can common treatments for these conditions, such as steroids for asthma.

• Endocrine (hormone) diseases. Growth can be affected by some conditions that disrupt hormones. Thyroid hormone is essential for normal bone growth. The pituitary gland in the brain secretes several hormones, including growth hormone. Growth hormone deficiency can result from injuries to the pituitary gland or brain. Cushing syndrome can impair height and cause weight gain. Precocious puberty is a condition caused by hormone problems. It often causes fast growth and tall height compared with other children of the same age. But growth stops at an early age. As a result, children with precocious puberty may be short as adults.

• Gigantism. Children will grow faster than normal if their pituitary gland makes too much growth hormone.

• Genetic disorders. This includes Turner syndrome, Down syndrome, and achondroplasia. Turner syndrome happens when one X chromosome is missing. This genetic disorder occurs only in girls. It causes poor growth and delayed or no puberty. Down syndrome is another common genetic disorder causing poor growth and short stature. It results from an extra 21st chromosome. Achondroplasia is the most common type of dwarfism, resulting in a problem changing cartilage to bone. It causes a child’s arms and legs to be short. It also causes a large head and other features.

Many disorders that can cause growth problems are idiopathic. That means their cause may not be fully known or understood.

Risk factors for growth problems include:

• Family history.
• Systemic disease.
• Genetic disorders.
• Ongoing malnutrition.

Most growth problems are noticed when the child appears smaller than their classmates, or when growth slows over several months. One main sign of a growth problem is slower height growth than expected each year. This means a yearly growth in height of less than about 2.2 inches (5.5 cm) between ages 2 and 4, less than about 2 inches (5 cm) between ages 4 and 6, followed by a yearly growth of less than 1.6 inches (4 cm) for boys and less than 1.8 inches (4.5 cm) for girls until puberty. In other cases, a baby may be abnormally small for their gestational age at birth.

Growth problems may be part of other problems or health conditions. Make sure your child sees their health care provider for a diagnosis.

In some cases, a growth problem may be diagnosed at birth when a baby is abnormally small for their gestational age. In other cases, a growth problem may be diagnosed when a child's growth is checked during regular exams.

Diagnosis of a growth disorder must be made by your child's provider. They may work with a pediatric specialist. The provider will ask about your child’s symptoms and health history. They may also ask about your family’s health history and do a physical exam. Your child's health and growth may be checked over several months.

Your child may also have tests, such as:

• Blood tests. These are done to check for hormone, chromosomal, or other disorders that can cause growth problems.
• X-ray. This test uses a small amount of radiation to make images of tissues inside the body. An X-ray may be done of the left hand and wrist. This can estimate your child's bone age. With delayed puberty or hormone problems, bone age is often less than calendar age.

Many conditions that cause growth problems can be managed or corrected with medical treatment. Treatment for growth problems will be based on:

• What may be causing the growth problem.
• How severe the problem is.
• The child's current health and health history.
• The child's ability to deal with medical procedures and take medicines.
• The parents’ wishes about treatment.

Some children may have poor self-esteem or depression because of their height.

Children who are shorter or taller than their peers may have poor self-esteem or depression. It’s important to talk about these problems with your child and your child's provider. The provider can recommend support groups for you and your child.

Talk with your child's provider about your child's potential adult height. If your child's growth problems are caused by a condition that can be treated, work with your child's providers to create an ongoing plan to manage your child’s condition.

Talk with your child’s provider if you are concerned about your child's growth.

• A growth problem means that a child falls either below or above the average range of growth for a child's age, sex, family history, or racial background.
• Growth disorders have many causes. They can include genes, illness, or problems with hormones.
• Most growth problems are noticed when the child appears smaller than their classmates, or when growth slows over several months.
• One main sign of a growth problem is when a child grows less than about 1.4 inches (3.5 cm) a year after their 3rd birthday. In other cases, a baby may be abnormally small for their gestational age at birth.
• Many conditions that cause growth problems can be managed or corrected with medical treatment.
• Children who are shorter or taller than their peers may have poor self-esteem or depression. It’s important to talk about these problems with your child's provider. They can recommend support groups for you and your child.

Tips to help you get the most from a visit to your child’s provider:

• Know the reason for the visit and what you want to happen.
• Before your visit, write down questions you want answered.
• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are and when they should be reported.
• Ask if your child’s condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if your child does not take the medicine or have the test or procedure.
• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your child’s provider after office hours or on weekends. This is important if your child becomes ill and you have questions or need advice.