How To Deal With Delayed Growth In Children



Background


Every child's babyhood is significant for his or her overall health and development. Healthy development indicates every child born needs are met in respect with social,emotional and educational needs. And even healthy diet, active lifestyle , and sufficient sleep also can make a big difference.


Moreover, child's cognitive abilities, language usage, and physical growth was largely ignored throughout the human history as children were often anticipated as small versions of adults and failed to give utmost attention during babyhood. The importance to the child development emerged early in the 20th century, but people were more concerned about their child's bizarre conduct. Sooner or later, other topics including typical child growth as well as the influences on their adolescence was also given equal importance.


The fastest period of growth is before birth when baby grows from almost zero to a length of about 50cm in nine months with an average growth of 5.5cm per year at eight year old. During puberty, growth speeds up again which is called as pubertal growth spurt. Interestingly, before puberty, boys and girls grow on same pace but during puberty boys grow more than girls. The average height of an adult man is 14cm taller than the average height of an adult woman.


During puberty, the growth plates in the bones called epiphyses mature, and at the end of puberty they fuse and stop growing. The growth of skeleton does not stop at the same time; hands and feet stop first, then arms and legs and finally the spine. Growth slows down and stops when a child has attained puberty and has reached adolescence stage.


Normal growth is controlled by a number of hormones:

  • Growth hormone, made in the pituitary gland

  • Thyroid hormone

  • Sex hormones, testosterone or oestrogen, which are important for growth during puberty


Growth hormone is a chemical messenger released from a part of the brain known as the pituitary gland. It not only help children become taller but also sends messages to almost every part of the body telling it to grow and function and includes, muscles, bone, heart and brain affecting cardiac function, mental agility and even ageing. A growth hormone disorder can lead to reduced growth along with a number of health issues.


Growth problems” is broad phrase and cannot be summed up in few key points as it covers every aspect of child’s insufficient growth.

  • The child's height below the 3rd or 5th percentiles on a growth chart is considered short . Usually short height children inherit their parents and only a few will have a specific and treatable medical growth problem.

  • A growth problem may be detected at birth or after few years if your child is abnormally small for his age i.e look underdeveloped compared to his peers.


The growth delay may be caused by an underlying health condition, such as growth hormone deficiency or hypothyroidism. In some cases, early treatment can help a child reach a normal or near-normal height..


Measured in height, “normal” growth is described as growth of:

  • 0 to 12 months: about 10 inches.

  • 1 to 2 years: about 5 inches.

  • 2 to 3 years: about 31/2 inches a year

  • 3 years to puberty: about 2 inches a year


Key points about growth problems in children

  • Growth disorders might be result of family genes, illness, or problems with hormones.

  • One main sign of a growth problem is when a child grows less than 3.5 cm (about 1.4 inches) a year after his or her 3rd birthday. In other cases, a baby may be abnormally small for his or her gestational age at birth.

  • Many conditions that cause growth problems can be treated with medical treatment.

  • Delay in growth in children self-esteem issues or depression. It’s important to talk about these problems with concerned pediatrician.

  • The primary symptom that may indicate a growth problem is when a child grows less than 2 inches a year after his second birthday. Other symptoms may include: slow development of physical skills, such as rolling over, sitting up, standing, and walking, delayed social and mental skills.


Types Of Delayed Growth In Children



#1 Growth hormone deficiency (GHD)














When the child's body is not producing enough growth hormone i.e the portion of the brain secreting and stimulating growth hormone will not function properly then it is called as growth hormone deficiency. This means that growth hormone is not released in high enough levels to stimulate normal growth. And it affects 1 in every 30,000 children per year.

.GHD can occur at any time from birth, and sometimes isn’t diagnosed until adulthood.



#2 Malnutrition and malabsorption











Malnutrition and malabsorption can occur if a child is not consuming sufficient nutrients, which can lead to a reduced rate of growth and weight. In addition, insufficient nutrient also result into Crohn’s disease.Besides, it affects the release of growth hormones, lowering the amount in the body. Unfortunately, children that are malnourished will have reduced growth.


In some children, the growth issues come before the clinical symptoms of bowel disease by a few years which is why it is vital to regularly measure the growth of your child.



#3. Chronic kidney disease (CKD)











CKD can occur as the result of a number of different factors, from genetic to physical. They have reduced renal function leading to reductions in calorie intake, electrolytes and production of growth hormone. All of these factors can negatively impact growth in children. And if these underlying factors are treated with efficient therapy in early days of CKD, patients then they might embrace normal adult height and in most of the cases children with CKD will hopefully provided with a kidney transplant for faster results.



#4 Idiopathic short stature (ISS)









Idiopathic generally refers to a condition where cause of the delayed growth is unknown and also difficult to diagnose due to unknown genetic factors. ISS can be caused by mutations to genes involved in the function of growth hormones and growth plate physiology. This growth disorder involves complex diagnosis thorough past history, physical examination, growth calculations, assessment of bone age, and eventually some laboratory investigations.



#5 Constitutional delay of growth and puberty














Constitutional growth delay refers to children who are small for their age but who grow at a normal rate and have delayed bone age which means skeletal maturation is younger than their age in years. Although puberty may be delayed, they tend to catch up with their peers when they reach adult height




#6 Familial short stature












Children with familial short stature are extreme case of short height of the growth chart (below the 3rd percentile) and their growth is dependent on their parents’ heights. This does not affect overall health & is generally considered to be appropriate for their genetics.




#7 Small for gestational age (SGA)










In small for gestational age growth disorder growth of baby is impaired and abnormal and it can be caused by a number of factors, including genetic, maternal, placental and demographic. Often the exact cause is not known. But many babies embrace normal growth within the first two years of life; however, some children will remain shorter or sometimes need growth hormone therapy to help them to grow.



#8 Noonan syndrome (NS)















NS is a genetic disorder that occurs in both boys and girls. It is caused by mutations to certain genes critical for the growth and regulation of cells. Doctor often recognize certain facial and skeletal features, plus the presence of heart problems. Besides, early treatment can cure most of the children with NS to reach an adult height within the normal range.




#9 Silver-Russell syndrome (SRS)














SRS or Russell-Silver syndrome (RSS) is a rare genetic growth disorder. Children are generally born smaller than expected with distinct facial features. Sometimes different parts of the body will grow at different rates. Diagnosis of SRS can be difficult due to the varied features and symptoms. So, the healthcare professional will look at the physical symptoms and perform follow-up measurements of growth.



#10 Turner syndrome (TS)












TS is one of the most common type of growth disorder in girls and women, affecting 25–50 per 100,000 females. On average, girls with TS tend to reach an adult stature that is 20 cm less than target height. Besides, due to TS females also have significant challenges to maintain overall health and wellbeing.


During Initial days when TS is suspected by the doctor a process called karyotyping is performed and also chromosomes are looked at in detail by analysing a sample of blood. There are various different therapy and it depends on patient's diagnosis results. It is crucial to diagnose TS sooner rather than later.



Consequences Of Growth Disorders


  • Physical symptoms - Physical symptoms generally consist of pain or tiredness. Some children may have to deal with joint or weight problems too.

  • Physical development – Growth disorder can lead to issues with development of other tissues and organs, such as the lungs.

  • Practical problems – Growth disorder create difficulties in finding clothes of perfect size or shoes to fit. And also have to face difficulties in carrying out everyday tasks such as sitting at a school desk or even going to the toilet can be difficult for some children.

  • Emotional issues - Short height children often become victim of bullying at school or even hurtful comments made by strangers in public can be very disappointing.




Causes Of Delayed Growth In Children


a. Hereditary - The child's short height is part of his or her family's pattern of inherited short height.


b. Delay of growth and pubertal development- Child tends to be shorter than average and after puberty grows at a normal rate. These children usually get normal height in adulthood.


c. Low immunity - The child is constant prone to malnutrition, digestive tract diseases, kidney disease, or any chronic diseases and stress can cause growth problems.


d. Hormonal Imbalance - Thyroid hormonal imbalance will result in delay in growth in children as it is essential for normal bone growth. Growth hormone deficiency can result from injuries to the pituitary gland or brain. Besides, children will grow faster than normal if their pituitary gland makes too much growth hormone.


e. Intrauterine growth restriction (IUGR) - Smoking during pregnancy or not enough prenatal care can affect growth of baby in the uterus. The baby is born smaller in weight and length than normal.


f. Genetic disorders - This includes Turner syndrome, Down syndrome, and achondroplasia. Turner syndrome is when the child has too many, too few, or abnormal chromosomes. Down syndrome is result of extra 21st chromosome. Achondroplasia is the most common genetic bone disease. It causes a child’s arms and legs to be short.


g. Skeletal abnormalities - Achondroplasia is a type of dwarfism in which the child's arms and legs are short in proportion to his/her body length. The head is often large and the trunk is normal-sized.


h. Precocious puberty - It is a growth disorder during adolescence the child is tall for his age initially, but due to rapid bone maturity, growth stops at an early age and the child may be short as an adult.


i. Idiopathic situation - It is a situation wherein their is no known cause for the growth problem.


j. Failure to thrive - When children younger than age 3 underweight or do not grow as expected may have a problem called failure to thrive. This is usually caused by a feeding problem or poor diet.



Other Causes -


Insufficient calorie consumption







In 95% of cases children are not consuming sufficient calories due to a variety of reasons or a parent has no knowledge about nutrition required by their child. It can also happen to a active toddler who is less interested in eating. Besides, for infants in their initial stage delay in growth can be due to an inadequate supply of breast milk or improperly mixing formula.


Mental issues of breast-feeding mom









The mental disorder of breast-feeding mom may not adequately feed the child or might accidentally mix the formula and there are high chances for too much dilution.



Oral or neurological issues










A child may also not eat well if they have oral sensitivity or neurological issues like cerebral palsy or a cleft palate which eventually such problems may affect their ability to swallow food.


Vomiting








Due to severe acid reflux or neurological issues sometimes a child cannot keep food in stomach and most of the times child recovers well and likely to improve and their growth will continue without issue. But sometimes the younger infant has to undergo special evaluation i.e abdominal ultrasound for detecting cause behind excessive vomiting as it might narrow the outlet of the stomach called pyloric stenosis.



Gastrointestinal disorders









The excess consumption of gluten in child's diet affect the lining of the bowel including celiac disease and can also cause children to have poor weight gain.


Thyroid and metabolic issues







An overactive thyroid will affect child's metabolism by burning calories too fast which will eventually slow down child's growth.


Heart conditions









A child with a heart disorder might suffer a heart failure and also due to heart problems may not eat well due to breathing issues. The heart disorder will badly affect the immunity power of the child.



How delay in child's growth diagnosed?


The best "test" is to monitor the child's growth in 6 months of time frame using the growth chart. And also can visit pediatrician and complete medical history and physical examination, diagnostic tests. It includes:

  • Physical examination of the child and medicines are prescribed accordingly. Then health & growth of the child is observed over several months.

  • X-ray of the bones and internal organs on film to determine maturity and growth potential of bones.

  • Examining the functions of the pituitary gland

  • Doctor also asks few questions to determine in case if their is other cause of delay in growth of child. Questions like - Any complication in mother’s pregnancy, the child’s length and weight at birth, the heights of other people in their family and also information about other family members who have experienced growth delays

  • Sometimes doctor recommends blood tests to identify problems with hormone imbalances or help detect certain diseases of the stomach, bowel, kidney, or bones. In some cases, the doctor might ask child to stay overnight in the hospital for blood testing as two-thirds of GH production happens during sleeps. .

Precautions To Deal With Delayed Growth In Children


Growth charts are the best tool to assess a child’s growth and overall health. Children’s height and weight usually, though not always, follow a given percentile from birth to adulthood. During the first two to three years of life, it is not uncommon to see a child’s growth deviate from its previous percentile, either upward or downward.


Every parent should track their child's growth pattern at home at least twice annually with the help of growth charts. Early signs of abnormal growth include fitting into the same clothes for more than one year; younger sibling or classmates of same age surpassing your child's height. And maintaining a normal growth pattern is a good indicator of a child's overall good health and well-being.


Growth charts are the best tool to assess a child’s growth pattern. Children’s height and weight usually, though not always, follow a given percentile from birth to adulthood. During the first two to three years of life, it is not uncommon to see a child’s growth deviate from its previous percentile, either upward or downward.


Every parent should not hesitate to discuss with doctor if you feel your child has symptoms of growth disorder.

Lets walk through some of basic symptoms of growth disorder for better clarity -

  • Slow growth may be noticed in infancy and continue through childhood, but in some cases may not be obvious until a child is 2 or 3 years old.

  • Short height than most children of the same age and gender.

  • Chubbiness though have normal body proportions

  • Younger looking face than children of the same age.

  • In older children, puberty may be delayed or may not come at all.


The medical treatment like early diagnosis and precautions can help some kids catch up with peers and increase their height. In simple words early detection of underlying medical condition and thereafter on time treatment may result in improved growth. For instance, growth failure due to hypothyroidism if detected well in advance then this can be treated with thyroid hormone replacement pills. Furthermore, the growth hormone injections for children with growth hormone deficiency, Turner syndrome, and chronic kidney failure may also help kids reach a more normal height. The psychology treatment also should be given importance for overall personality development of the child. Moreover, the kids who are very self-conscious about their size might need help in coping. So, evaluation and treatment by a mental health expert boost child's self-esteem which will help child focus off of height as a measure of social acceptance and also help the child to deal with any emotional difficulties.



Physiotherapy treatment is also helpful as people with growth disorders sometimes suffer with weak bones and less muscle strength. And physiotherapists with few stretching exercises and other relevant treatments will improve muscle strength and movement, while helping reduce any pain.


Along with appropriate medical treatments, regular physical exercise is vital to help maintain normal levels of bone mineral density and overall health of the child.

And in certain growth disorders child might experience sudden weight gain or even obesity. In these situations, it may be beneficial to seek the advice of an accredited dietitian.



How can you take care of your child?


Parents should build child’s self-esteem - Children with growth disorders who have friends with normal height might suffer self-esteem issues. So parents should try to develop child’s self-esteem by reminding child of his/her strengths. Your child may need counseling to help change views and expectations of himself.


Parents should help child to understand his problem - Help your child to accept the fact that treatment or that the growth delay is normal in your family. And also sometimes involving with other children who have similar condition can also help children may feel better that they are not alone and realize that its just a phase which will pass soon.



Parents should be cautious and well educated of alternative treatments - Its always better for every parent to check with your healthcare provider before giving supplements, changing to a different eating habits diet, or using other kinds of alternative treatments on your child.


Conclusion

All in all, before jumping to any conclusions, dont ignore the fact that some children are naturally short and will fall lower on the growth percentile chart than other children due to inbuilt genes. In this case, there may be no cause for concern. Growth parameters are specially measured with the goal of identifying children with abnormalities in growth of a child.


Moreover, careful tracking of childhood growth is a sensitive indicator of health and well-being an essential component of sound pediatric care. Detection of unexplained acceleration or deceleration in growth rate or tracking along a disparate percentile considering family height genetics should prompt investigation. The earlier the the cause for delay in growth condition is treated, the better the chance that a child will grow to near-normal adult height.



Sources


https://hhma.org/healthadvisor/pa-growthpr-pep/


https://www.verywellfamily.com/the-short-child-2633629


http://www.growingup.net/worried-about-your-childs-growth/seeing-your-doctor


https://kidshealth.org/en/parents/growth-disorder.html#:~:text=Treating%20a%20Growth%20Disorder&text=Growth%20failure%20due%20to%20hypothyroidism,reach%20a%20more%20normal%20height.


https://morethanheight.com/en/growth-disorders/types-of-growth-disorders/


https://www.healthychildren.org/English/health-issues/conditions/Glands-Growth-Disorders/Pages/When-a-Child-is-Unusually-Short.aspx


https://www.healthline.com/health/delayed-growth-symptom#:~:text=A%20growth%20delay%20occurs%20when,normal%20or%20near%2Dnormal%20height.


https://www.childrenshospital.org/conditions-and-treatments/conditions/g/growth-problems


https://childrensnational.org/visit/conditions-and-treatments/stomach-digestion-gi/growth-disorders


https://www.cdc.gov/ncbddd/childdevelopment/facts.html


https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=90&contentid=P01956


https://www.verywellmind.com/child-development-theories-2795068#background

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