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Growing issues : What to do when your child is too short or growng up faster than expected

Every parent wants their children to grow up big and tall and healthy.
 
What can be done if your child is the shortest in class ? Or if the child is just not putting on weight and not growing well at all
Or if your child is towering over the other children and also beginning to show signs of puberty ?
Or if your son seems to be developing breasts ?
Or if your daughter has already had her periods starting up, and her height growth seems to be slowing down ?

These are all issues where a paediatric endocrinologist ( a paediatrician specialising in hormone disorders ) can help.




The slowing growing child and the  short child

The first issue is to determine if your child is actually short. This seems strange, but we need to see if the child is actually short for age and gender ( boy or girl ) and for  ethnic group as well as the stage of pubertal development.

Sometimes, the child may just be the youngest in class or the classmates may belong to other ethnic groups which are taller. Or the child may have been born premature or small for gestational age ( ieg poor growth while in the mother’s womb ) or maybe the child had a difficult first few years, with recurrent infections and poor weight gain, resulting in the current shortness in height. Next we must assess the child’s  physical maturity and skeletal maturity and examine the stage of growth which is taking place.
 
Then we will check to see if these is any  current medical problem holding back growth

Sometimes,  the other classmates may already have entered puberty while your child’s pubertal development has not started yet. Delayed pubertal onset may be a family characteristic or it may be because of a medical problem such as an underactive thyroid, or  the result of a chronic illness like poorly controlled asthma or chronic arthritis.  Some children with untreated nasal allergies or obstructive may grow poorly. Children under severe emotional stress or deprivation also tend to secrete less growth hormone .
 
The treatment of these children varies and has to be individualiised for best results, because no two children are completely alike, even when they are siblings

Sometimes, no treatment is necessary other than a change in diet and lifestyle.

At other times, the key issue is to identify and treat the underlying medical condition which is holding back growth, such as  a chronic illness. Examples of these would be hypothyroidism, hypogonadism and celiac syndrome. Sometimes an eating disorder or excessive exercise ( which can be a manifestation of an eating disorder ) may be the underlying cause for poor growth and this may not be recognized by the parents.

Occasionally, subcutaneous growth hormone may be recommended for augmentation of height potential.




The rapidly growing child

Tall parents often have tall children and tall children often end up as tall adults.  But not always. A different type of problem sometimes arises when children grow too fast, and end up shorter than they otherwise would have been. Sometimes this happens when early growth is very good and puberty is triggered early. I often see children who have had early puberty , which means that they were big and tall in primary school and their parents were happy that they were growing well at that time, but after a while, the parents and the child notice that other people have caught up and surpassed them in growth. If seen early, we can do something, but  all too often, parents leave it too late, and the tall child ends up as a short adult.

Puberty is the name of the process of the child developing secondary sexual characteristics like breast development and menstruation in girls, as well as  the change of voice and genital growth in boys.

During puberty, the sex hormones and increased growth hormone secretion will cause a rapid gain in height, but after this pubertal height spurt, growth usually slows down and stops by the mid or late teens.

By the time a girl has started menstruating or a boy has had a voice change, the maximal growth rate has already passed. Typically, a girl will finish growing within 2-3 years  after the first menstrual period.

So if a child is still relatively short at the start of puberty or by the time menstruation starts, medical help should be sought.




Timing of puberty : when to seek help ?

In our local context ,  pubertal development in girls will  mostly start between 9-11 years and in boys from 11-14 years. I f a girl has not shown any signs of puberty by 12 years of age or a boy by 14 years of age, they should seek medical help from a doctor familiar with paediatric endocrine issues, and conversely, if puberty is seen to be starting too early, you should also see a doctor experience in this area. 

The control of the age of onset of a child’s puberty, length of the growth spurt and eventual final height result from the interaction of the child’s own state of health, influence of the environment and also the  genes inherited from the parents. It is a complex process, and while the pattern of puberty in the elder brother or sister is a good indication of what we might expect in the next child, sometimes a completely different pattern is seen.

The treatment of these conditions will vary according to the child’s needs. Not every child needs to be treated medically, but a child who is suspected of having either very early or very late puberty should be assessed. Rarely , precocious puberty may be the result of an abnormality in the brain which may require surgery.  A child may need to have puberty accelerated or delayed, and sometimes we may need to delay the completion of puberty while treatment is given to help the child catch up in height.




Pitfalls and misconceptions

There are many remedies for poor growth being advertised in the various media. Sadly, not everything you read about is true, and many opportunists prey on the natural fears and aspirations of parents. Growth hormone is a protein hormone that has to be injected to be effective, and there are NO oral or inhaled forms of this hormone. No medications can help you grow taller if your bones have completely fused, so it is unlikely that medications will work to help you grow taller when you are an adult.  It is also not always accurate to say that children will eventually catch up in growth or that you can just feed the child with more goodies and supplements, because there are some children who will never catch up without proper treatment of their underlying condition.




In summary

Modern medicine is now able to help intervene in cases where the process of growth and puberty is not optimal. While lifestyle changes and nutritional support are important, other modalities of treatment may be needed and are available in Singapore. However, the doctor cannot help a child whom he or she has not seen, so it is important for parents to recognize that the child has a problem and bring the child to the attention of a doctor familiar with both diagnosis and treatment of growth problems.



For more information, please contact clinic at:
Camden Medical Centre
One Orchard Boulevard #02-06
Singapore 248649
Tel: (65) 6235 3678
Fax: (65) 6235 2618
SMS: (65) 9710 7136
General email, appointments and enquiries:


 
Growing Issues
Paediatrics & Endocrinology
Adolescent Medicine
Growth
Diabetes
Insulin Pumps
Glucose Monitoring and CGMS
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