Our society places a high value on a person's height, almost more than any other characteristic. Children who are shorter than their peers face significant challenges. They are often teased, and are on the receiving end of name-calling and bullying. They may deal with their frustration by becoming depressed, angry, or aggressive. If they do not experience a growth spurt, they will face other challenges as adults. Parents need to be aware of these challenges so they can help their children become happy and productive. This page describes some of the causes and treatments for short stature in children. Administering Human Growth Hormone is one treatment, in certain cases, but we also explore other ways that parents can help their children.
Genetics play the most important role in determining a child's final height but there are some simple, common sense steps parents can take to maximize their children's growth. Growing children should:
- Eat healthy foods, especially fruits, vegetables, breads, rice and pasta. The fast foods that so many children love should be the exception, not the rule.
- Always get a good nights sleep. Most growth takes place during sleep.
- Exercise as much as possible. Children in the United States have become very sedentary. Without exercise, nutrition goes into building fat instead of height.
- Don't Smoke!! If possible, children should also stay away from people who do. Second hand smoke has been linked to reduced growth.
If you are concerned about your child's growth, the first thing you should do is contact your pediatrician. Depending on your child's age and height, the pediatrician may decide to begin diagnostics or refer you to a pediatric endocrinologist. A pediatric endocrinologist specializes in the hormone system of children. The hormone system regulates growth in children, as well as many other biological functions. It will be helpful to the physician if you provide information about your child's growth patterns. This could be as easy as providing a representation of the wall or door jam you use to measure your child's height, since he or she began to stand. Your regular health care provider should also have a record of your child's growth.
The information presented here is meant to help parents discuss their child's growth with their pediatrician. It is not a substitute for those discussions.
The physician should first discuss with you the possible causes of short stature. It is important for parents not to jump to conclusions. They must allow enough time for the physician to conduct the right tests. Testing may require six months to a year and may include detailed recording of height changes over time. As you will see, there are many possible causes for short stature. Each cause may or may not be treatable.
The most likely reason for a child to be short is because his or her parents are short. Children generally inherit all of their physical characteristics from their parents. Besides height, some of the most obvious are eye color, hair color, facial features and perhaps intelligence. Children from short parents can be expected to reach an adult height about the same as their parents. However, children often grow taller than their parents because today's knowledge of nutrition and medical practices are much improved over the previous generation. Treatment with Human Growth Hormones is not indicated in these cases because the child's growth hormone production is normal according to their physiology.
Constitutional Growth Delay
In Constitutional Growth Delay, children grow slowly at first, then during puberty they grow quickly, reaching a normal height approximately the same as their parents. Boys are more likely to have Constitutional Growth Delay than girls. Children with Constitutional Growth Delay may experience growth spurts before they start school but do not catch up to their peers until puberty. Constitutional Growth Delay may run in families.
These conditions indicate a problem with the child's physiology and are grouped into three categories, Systemic, Endocrine and Congenital. Treatment may or may not be possible depending on the specific condition.
Idiopathic Short Stature
When children do not demonstrate any symptoms, and test results do not indicate a problem, they are said to have idiopathic short stature. These children are physically and mentally normal, but they are short. Idiopathic short stature is uncommon. In 2003 the FDA approved the use of Human Growth Hormones for boys not expected to grow more than 5' 3" and girls not expected to grow more than 4' 11". This decision remains highly controversial. We've collected almost 100 opinions and New Articles, the majority being unfavorable. One study showed an average growth of 3" inches when HGH injections were given to children with Idiopathic Short Stature.
The Physical Exam
After the first consultation, the physician or pediatric endocrinologist will conduct a series of tests to determine if there is a problem, and if possible a course of action.
- Height Measurements
The first thing the doctor will do is measure the child and ask for information about the child's previous growth patterns and the heights of his or her parents and other relatives. With this information and a Standard Growth Chart, the doctor can determine if the child is on the right growth path according to his or her genetics, or if there might be a more serious problem.
- Blood Tests
Blood Tests will be performed to determine if there are any physiological problems. Some conditions are easily determined while others are more difficult. The lack of adequate production of Growth Hormone (see Endocrine Conditions) is difficult to determine because it is produced in spurts and does not remain in the blood stream very long. Many blood samples may be needed over the course of a few months to obtain an accurate reading. Alternatively, the doctor may advise that the child be placed in a hospital for a few days so the blood can be checked every few hours.
X-Rays of the child's hand can indicate his or her growth potential. Each long bone in the body has a growth plate on one or both ends where growth occurs. The doctor can view the structure of the growth plates and the distance between the bones to determine how much future growth is possible. The hand is a good part of the body to use because there are so many bones in it. As children reach puberty, the growth plates close and no further growth occurs. If the X-Rays indicate that more growth is possible and that the child is low in growth hormones, then growth hormone treatment is indicated. However, if the growth plates are nearly closed, Growth Hormone treatment is not likely to produce positive results.
Human Growth Hormone Treatment
Human Growth Hormone Treatment is an expensive proposition. It can cost up to $1,000 a week, depending on how much growth hormone the child needs. Insurance coverage may not be available depending on the parent's plan, which could place a huge financial burden on the family. The first treatments began in the mid-1950's and used Human Growth Hormone retrieved from cadavers. Certain diseases could be passed from the cadaver to the child and introduced risks in the treatment. Since 1985, Human Growth Hormone has been produced using Recombinant DNA (rDNA). rDNA technology eliminates the possibility of passing any diseases to the child.
While under treatment, the child receives injections three to seven times per week. For treatment to be effective, he or she must continue to receive injections until the end of puberty.
It is important for parents to understand that Human Growth Hormone treatment should only be applied when it is determined that the child is not producing enough Growth Hormone. Too much Growth Hormone could trigger an early onset of puberty, closing the growth plates and reducing the child's final height. Whatever your physician advises, you may want to consider a second opinion, especially from a pediatric endocrinologist.
Parents who want to help their children cope with their differences may want to consult our library. We recommend these sections:
Parents with Short Children
The books listed in this category were written for parents helping their children deal with their short stature.
Children and Young Adults
Books for children and young adults often show, by example, how one can live a good life though being different from the rest. One word of caution. Throughout much of literary history, short people have been portrayed as evil (e.g., leprechauns, gnomes) or deserving of punishment. If you are a parent shopping for a book for a child, we suggest you carefully determine the book's appropriateness for your situation.
For further reading we recommend the following sites:
Human Growth Foundation
The Human Growth Foundation helps persons with disorders of growth or
growth hormone through education, research, support, and advocacy.
- The Endocrine Society
The Endocrine Society claims to be the largest and most active organization devoted to the research, study and clinical practice of endocrinology. Membership tops 10,000 people in 80 countries and includes scientists, educators, clinicians, practicing MDs, nurses and students.
- Kids Height Predictors
This Height Predictor at Web MD factors parent's heights and child's current age, height and weight.
- Other Kids Height Predictors
This site offers three height predictors based on
- The heights of the parents (did not work the last time we checked)
- The child's height at two years of age
- The child's current height.
- Genentech's Growth Hormone Site
Genentech, Inc. is a biotechnology company that uses human genetic information to develop, manufacture and market pharmaceuticals. Their Growth Hormone site contains excellent information, though the site is difficult to navigate.
- Lilly: Humatrope
For a second opinion, Lilly, a pharmaceutical company, also provides good information on human growth.
- University of Maryland Medical Center: Division of Pediatric Endocrinology
The Division of Pediatric Endocrinology offers a range of specialized services to support physicians' efforts to evaluate and manage patients with endocrine disorders, including growth problems.
Physicians Committee for Responsible Medicine.
The page provides an excellent list of the psychological and physical risks of giving Human Growth Hormone treatments to children who are short but are not deficient in growth hormone.
Child Abuse & Neglect: Psychosocial Dwarfism
This eMedicine site explains how child abuse can lead to dwarfism, even when there is no genetic component.
Kid's Health: Feeling too Tall or Too Short
This article is intended more for children than for their parents. It provides an honest assessment of the options available but could deal more effectively with the real difficulties some children face.
- Britt Randall's: Human Growth Hormone's Effects on Normal and hGH Deficient Children
Though somewhat cluttered, this site provides good specific information about Human Growth Hormone treatments.