Parents are most concerned about their children's growth issues. Being too short, overweight, or underweight can cause parents great anxiety. Just like Messi, who recently helped Argentina win the World Cup, he was diagnosed with "dwarfism" – growth hormone deficiency – as a child and required nightly growth hormone injections. Regarding children's growth problems, paediatric specialist Dr. Xu Ziyun shares the following information.
What is growth hormone deficiency?
The pituitary gland in the brain secretes growth hormone, which is an important component for healthy development and growth in children. Growth hormone continues to regulate multiple physiological and metabolic processes throughout different stages of life.
Growth Hormone Deficiency, while not common, can lead to short stature, fragile bones, and poor athletic ability if left untreated. According to research data, approximately one in every 4,000 to 10,000 people suffers from GHD, resulting in short stature. Children with GHD may also have different facial features compared to typically developing children, and may have higher body fat with a more prominent abdomen. Fortunately, cognitive function is not affected.
What is a normal growth chart? How is it assessed?
Growth charts are generally used as an objective measure to assess a child’s growth and development.This is a percentile chart based on gender, age, weight and height. Generally speaking, during infancy, a baby’s growth measurements falling between the 97th and 31st percentile lines are considered within the normal range.However, if a child’s growth measurements persistently deviate, or deviate excessively, from their previous percentile on the growth chart, it is advisable to consult a paediatrician as soon as possible for further examination and assessment.
Doctors also refer to a Growth Chart when determining if a child has dwarfism. If a child’s height is at or below the 3rd percentile on the growth chart, they are considered to have dwarfism.
Three key examinations to help diagnose dwarfism
Regarding the diagnosis of dwarfism, doctors will conduct detailed examinations on children and inquire about their past health conditions and family medical history. Subsequently, based on each child's situation, they will arrange corresponding blood tests, X-ray examinations, and even brain imaging scans. The aim is to find the underlying causes of short stature.
Measure your child's height and weight every 4-6 months.
If parents are concerned about their child's height, they can have their height measured regularly every 4-6 months. Generally, children aged 4-10, before puberty, grow 4-6cm per year. If parents notice their child is shorter than other children of the same age, or is growing at a slower rate, it is recommended that they consult a paediatrician as soon as possible for an examination.
Growth hormone deficiency
Some babies are already relatively small at birth; ‘small for gestational age’ (SGA) refers to babies whose birth weight is 10% or less than the average weight for their gestational age. This is one of the causes of short stature.There are many other causes of short stature, which can generally be categorised as non-pathological or pathological.
Non-pathological causes include: genetic factors, delayed individual maturation, developmental delay, and idiopathic short stature.
Pathological causes include: low birth weight, malnutrition, chronic illnesses such as chronic kidney disease, genetic or chromosomal abnormalities, and even endocrine diseases, such as hypothyroidism or growth hormone deficiency.
How to treat dwarfism?
Treatment for dwarfism depends on the underlying cause. For example, if it's due to malnutrition/poor lifestyle habits or medication, then attention should be paid to a balanced diet, rest, and exercise, and medication may need to be adjusted. If it's due to endocrine disorders or hypothyroidism, then supplementing the thyroid hormone will restore normal growth. If growth hormone deficiency is found, height growth after receiving growth hormone therapy generally shows a significant effect.
What is growth hormone?
Growth hormone, which is produced by the body, is secreted by the anterior pituitary gland. It is transported by the bloodstream to the liver and major organs throughout the body, particularly bone and muscle cells, where it stimulates growth. In addition to this, growth hormone also regulates sugar and fat metabolism.
The side effects of growth hormone can include, but are not limited to: * Pain, swelling, or redness at the injection site * Headaches * Muscle or joint pain * Numbness or tingling sensations * Fluid retention (oedema) * Increased blood sugar levels * Carpal tunnel syndrome * Increased cholesterol levels In children, there's a risk of the growth plates in the bones closing too early. In adults, there's a small risk of developing diabetes, fluid retention, muscle and joint pain, and carpal tunnel syndrome. It's important to discuss potential side effects with your doctor.
Growth hormone used for treatment is a synthetic drug that has been used to treat dwarfism for over 30 years. Its efficacy and side effects have been extensively studied scientifically. A small proportion of children may experience adverse side effects such as headaches, joint pain, oedema, and hyperglycaemia. Some may develop benign intracranial hypertension, leading to symptoms like headaches and vomiting. These side effects generally disappear after treatment is stopped. However, very rare but serious cases, such as slipped capital femoral epiphysis, require surgical treatment. Overall, however, injecting growth hormone to treat dwarfism is generally safe.
The US Food and Drug Administration (FDA) has currently approved the use of growth hormone for the treatment of growth hormone deficiency, Turner syndrome, Prader-Willi syndrome, short stature caused by SHOX gene deletion, short stature in children with chronic renal failure, idiopathic short stature, and children born small for gestational age who remain short. However, before using these medications, a thorough assessment by a doctor is required to determine if treatment is suitable.
Growth hormone is most effective when used before puberty.
The cost of growth hormone treatment depends on the dosage required for the child. For children with appropriate short stature, growth hormone is most effective when used before puberty, with earlier treatment yielding better results. Regarding the duration of treatment, doctors usually recommend discontinuing use after the child's puberty has ended and their growth plates have closed.
The effectiveness of dietary supplements for increasing height is questionable.
Although injecting growth hormone can offer a chance to help children grow taller, it is also important to ensure they have a balanced diet, appropriate exercise, and adequate rest at the same time. There are various other height-increasing methods circulating in the market, such as height-increasing milk powder, height-increasing pills, and even surgical height increase. The former lacks sufficient scientific evidence and confirmed efficacy, while the latter carries various surgical risks and sequelae.
Don't miss the golden period for growth hormone therapy.
Occasionally, young people come in seeking advice on how to increase their height. Recently, I met a 15-year-old boy who is 157 cm tall (growth curve 3-10%); he has some acne on his face and a rather deep voice.As his parents are not particularly tall either, his median genetic height is approximately 166 cm. Looking at his past growth records, he was born small for gestational age and his growth has consistently remained within the 3–101 TP3T percentile.The clinical physical examination revealed no abnormalities, and his general health was excellent. His bone age corresponds to that of a 16-year-old. Both the young man and his parents were keen for him to undergo growth hormone therapy; however, his growth plates are already nearing closure, and under these circumstances, growth hormone therapy would not yield satisfactory results. They were understandably disappointed upon hearing this.
While this young boy's current height might not reach 166 cm, his predicted adult height can still fall within the genetic height estimation range. This example highlights that if parents notice any issues or are unhappy with their child's height, they should consult a doctor early to address the problem. In these suitable cases, the application of growth hormone must occur before the growth plates close, otherwise, this "golden period" will be missed.
Reference: Department of Health website
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