Short stature in children should not be disregarded because it may indicate an underlying health problem writes Meera Murugesan
IT is every parent’s desire that their child grows healthy, tall and smart. Parents will provide the best possible nutrition, care and opportunities to nurture this growth. But what if, despite all their best efforts, the child does not grow to the appropriate height for his age?
Parents often take a “wait and see” approach. They may attribute the child’s short stature to hereditary or genetic factors or assume that their child will ultimately catch-up with his or her peers.
What if that does not happen? Is time running out for their child’s growth?
The fact is, there is a “growth timespan” for children. Not many people are aware that poor growth indicates a serious underlying health condition in some children. Thus, it’s crucial for parents to monitor whether their children are growing normally.
THE TALL TALE
In light of this, Novo Nordisk Pharma (M) Sdn Bhd (Novo Nordisk) has launched the “It’s More Than Height – It’s Health” awareness campaign to drive greater understanding on growth disorders among children and its potential impact on their health. This campaign coincides with International Children’s Growth Awareness Day which takes place each year on Sept 20.
A child’s growth pattern should not be taken only as a cosmetic or appearance issue says associate professor Dr Muhammad Yazid Jalaludin, consultant paediatrician and consultant paediatric endocrinologist and head of the Department of Paediatrics, Faculty of Medicine, University Malaya Medical Centre (UMMC).
“Growth is a key indicator of a child’s health and well-being. Accurately measuring and plotting a child’s height development on a growth chart should be conducted regularly by parents and healthcare professionals to facilitate early detection of growth issues,” he says.
There are many reasons that can lead to short stature in children such as genetics, illness and medications, nutrition and hormones he adds.
Slow growth in children is usually apparent between 2-5 years. If, after 5 years of age, the child grows less than 5cm a year or the growth rate drops by 2 or more percentiles in the growth chart, parents should seek help.
They should consult a paediatrician to conduct baseline measurements and history-taking to rule out other factors. If a hormone issue is suspected, the child should then be referred to a paediatric endocrinologist. Baseline blood investigation and stimulation tests can be conducted to assess if slow growth is actually due to growth hormone deficiency.
Growth hormones are a type of protein made by the pituitary (a small gland located below the brain in the centre of the head behind the nose). It stimulates height growth in children and adolescents and contributes to other important bodily functions such as maintaining muscle and bone mass, decreasing fat tissue and influencing blood lipid levels such as cholesterol and triglycerides.
Besides Growth Hormone Disorder or GHD (distinguished by abnormally short height due to the lack of growth hormones), other disorders that can also cause short stature in children are Turner Syndrome (a chromosomal condition that affects development in females where the most common feature is short stature and is evident by about age 5) and Small for Gestational Age or SGA (where a featus or an infant is smaller or less developed than normal for the baby's gender and gestational age).
Associate professor Dr Firdaus Mukhtar, consultant clinical psychologist and head of the Department of Psychiatry, Faculty of Medicine and Health Science, Universiti Putra Malaysia (UPM), says healthcare professionals, caregivers and educators need to pay special attention to the psychological, emotional and physical well-being of short stature children.
It is important to provide a supportive and nurturing environment to ensure stability as they go through the medical routines.
“Beyond health issues, short stature children may also experience a lower quality of life compared to their peers. They could be subjected to teasing and bullying at school, have lower self-esteem and face physical and social challenges.”
Thus, parents must be proactive in monitoring the growth of their children. If necessary, seek appropriate treatment at the earliest stage.
Short stature children will not grow or “catch-up” in height later in their development phase.
So, to “wait and see” until children are in their early teens minimises the timeframe available to address any growth issues as their bones will start to close (epiphyseal fusion) upon entering puberty.
The onus is on parents to refer to a paediatrician as early as possible. With early diagnosis and treatment, growth hormone deficiency can be treated to optimise good health and help children attain normal adult height.
BE AWARE
SIGNS that may indicate a medical condition causing short stature include:
*No growth or slower growth than expected (less than 5cm a year or the growth rate drops by 2 or more percentiles in the growth chart).
*Loss of appetite.
*Delayed puberty (absence of breast development by age 13 or absence of menstrual spotting by age 15 for a girl or absence of enlargement of the testes by age 14 for a boy).