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What Is a Growth Disorder?
A growth disorder is any type of problem in infants, kids, or teens that prevents them from meeting realistic expectations of growth. Disorders may include failure to thrive in infancy, failure to gain height and weight in young children, and short stature or delayed sexual development in teens.
Common Growth Disorders and Their Causes
This section will discuss a sampling of normal variant growth patterns, such as familial short stature and constitutional growth delay, and growth disorders, such as growth hormone deficiency and Turner syndrome.
Although it's common for newborns to lose a little weight in the first few days, some infants continue to show slower than expected weight gain and growth, a condition known as failure to thrive. Usually caused by inadequate nutrition or a feeding problem, failure to thrive is most common in children younger than age 3. Failure to thrive may also be a symptom of another problem, such as an infection or a digestive problem. Child neglect or abuse may also be associated with failure to thrive.
Shorter parents tend to have shorter children, a condition known as familial (or genetic) short stature. This term applies to short children who do not have any symptoms of diseases that affect growth. Children with familial short stature still have growth spurts and enter puberty at normal ages, but they usually will only reach a height similar to that of their parents.
Constitutional growth delay describes children who are small for their ages but who are growing at a normal rate. They usually have a delayed "bone age," which means that their skeletal maturation is younger than their age in years. (A child's bone age is measured by taking an X-ray of a child's hand and wrist and comparing it to standard X-ray findings seen in children of the same age.)
These children do not have any signs or symptoms of diseases that affect growth. They tend to reach puberty later than their peers do, with delay in the onset of sexual development and the pubertal growth spurt. But because they continue to grow until an older age, they tend to catch up to their peers when they reach adult height. One or both parents or other close relatives of these children often experienced a similar "late-bloomer" growth pattern.
Children diagnosed with familial short stature or constitutional growth delay often face social problems because they are short or don't enter puberty when their classmates do. "Most importantly, children and their families need to be reassured that their child does not have a disease or medical condition that poses a threat to their health or requires treatment," says Steven Dowshen, MD, a pediatric endocrinologist. However, these kids may need extra help coping with teasing by their peers or reassurance that they will grow and develop eventually.
Other Causes of Growth Disorders
Diseases of the kidneys, heart, gastrointestinal tract, lungs, or other body systems may lead to growth disorders. Other symptoms in children with these illnesses usually give clues as to the disease causing the growth delay. However, poor growth may be the first sign of a problem in some of these conditions.
Endocrine diseases (diseases involving hormones, the chemical messengers of the body) involve a deficiency or excess of hormones and can be responsible for growth failure during childhood and adolescence. Growth hormone deficiency is a disorder that involves the pituitary gland (the small gland at the base of the brain that secretes several hormones, including growth hormone). A damaged or malfunctioning pituitary gland may not produce enough hormones for normal growth. Hypothyroidism is a condition in which the thyroid gland fails to make enough thyroid hormone, which is essential for normal bone growth.
Turner syndrome, one of the most common growth problems, occurs in girls and is a genetic syndrome in which there is a missing or abnormal X-chromosome. In addition to short stature, girls with Turner syndrome usually don't undergo normal sexual development because their ovaries (sex organs that produce eggs and female hormones) fail to mature and function normally.
How Is a Growth Disorder Diagnosed?
The number of tests needed to detect a growth disorder depends on the findings at each step of evaluation. A short child who is healthy and growing at a normal rate may just be observed throughout childhood, but a child who has stopped growing or is growing more slowly than expected will often need additional testing.
Your child's doctor or endocrinologist will look for signs of the many possible causes of short stature and growth failure. Blood tests may be performed to look for hormone and chromosome abnormalities as well as to rule out other diseases associated with growth failure. A bone age X-ray is frequently done, and special scans (such as an MRI) can check the pituitary gland for abnormalities.
To measure the ability of the child's pituitary gland to produce growth hormone, the doctor (usually a pediatric endocrinologist) may perform a growth hormone stimulation test. This involves giving the child certain medications that cause the pituitary gland to secrete growth hormone and then drawing several small blood samples to check growth hormone levels over a period of time after the medications are given.
Treatment
Although the treatment of a growth problem is usually not an urgent situation, earlier diagnosis and treatment of some conditions may help kids achieve a more typical adult height.
If an underlying medical condition is identified, specific treatment may result in improved growth. Growth failure due to hypothyroidism, for example, is usually simply treated by giving the child thyroid hormone replacement therapy in pill form.
Growth hormone injections for children with growth hormone deficiency, Turner syndrome, and chronic kidney failure may help them reach a more normal height. "Human growth hormone is generally considered safe and effective," Dr. Dowshen says, although full treatment may take many years and not all children will have a good response. The treatment can be quite costly (approximately $20,000 to $30,000 per year), although most health insurance plans will cover the costs.
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