Growth Hormone Deficiency in Children

As parents, of course we want our children to grow up quickly, but we also worry about their stature being smaller than their peers. Short stature generally refers to being shorter than the 3-5% shortest children of the same age and sex¹. How can parents detect early signs of slow growth in their children? What treatments are currently available? Dr. Bi Huiwen, a specialist in pediatric endocrinology, believes that parents should continue to record the height of their children. If they continue to be below the standard or their growth is slow, they should seek medical advice early to avoid missing the golden opportunity for treatment.

What causes short stature? Children grow very quickly during the first two years of life, but then their growth begins to slow down. Until they reach puberty, height can increase rapidly again until the growth plates in the bones fuse (i.e., girls' bone age is about 14 years; boys' bone age is about 16 years). There are many causes of short stature, including:

1. Family inheritance
2. Delayed growth and puberty
3. Small for gestational age, that is, a baby whose birth weight is less than the same number of weeks
4. Endocrine problems such as growth hormone deficiency, hypothyroidism, and Cushing's syndrome
5. Chromosomal disorders such as Turner syndrome, Russell-Silver syndrome, and Prader-Willi syndrome
6. Metabolic bone diseases, such as rickets and osteogenesis imperfecta (brittle bone disease)
7. Unexplained short stature, etc.

The doctor will evaluate the child based on medical records and a physical examination. Weight and height will be measured and plotted on a growth chart. The child's height will also be compared to the parent's height. Dr. Bi reminded: "Parents should keep track of their children's height, which will help doctors review the growth records to determine the child's growth rate." If necessary, blood tests and X-rays will be performed to determine the cause of the short stature. Children suspected of having growth hormone deficiency may need a growth hormone stimulation test for diagnosis. Any child diagnosed with growth hormone deficiency should have magnetic resonance imaging (MRI) of the brain and pituitary gland to determine the cause.

Growth hormone deficiency in children

If your child develops the following symptoms, you should consult a doctor as soon as possible:

1. Severely short, well below the 3rd percentile for height
2. Small for gestational age and no catch-up growth after two years of age
3. Target height range below parents’ height estimate
4. Skeletal abnormalities
5. Having symptoms and signs of chronic diseases

Children’s Growth Hormone

Treatment depends on the underlying cause of short stature, and prescribing the right medicine is key. For example, thyroid hormone replacement therapy can be used to treat hypothyroidism; growth hormone can be considered for short stature caused by lack of growth hormone, small for gestational age without catch-up growth, Turner syndrome, Prader-Willi syndrome, and unexplained short stature.

Children's growth hormone treatment requires subcutaneous injection every day before going to bed. The growth hormone in the body can stimulate growth and cell reproduction and promote height growth. The effects of treatment vary from person to person. Some children with short stature may grow 4-10 cm taller in a few years. There are also some children whose response to childhood growth hormone varies greatly. Doctors will monitor the child's condition after treatment, including insulin growth factor (IGF-1) levels, fasting blood sugar, glycated hemoglobin (HbA1c), thyroid function and blood pressure. Dr. Bi added: "This treatment method is relatively safe, and the earlier the treatment is started, the better the effect will be, and the final height will be more ideal."

Children's growth does not happen overnight. Parents should pay more attention to their children's development. If you notice signs of growth retardation or have any questions, seek professional advice from your doctor.

Reference materials:

1. Child Health and Growth Educations. Growth Curve. 2021. Available at: https://www.cuhk.edu.hk/proj/growthstd/english/gs_using.htm [Accessed 14 December 2021].