Growth problems in children

What are growth problems?

A child's growth and development can be influenced by:

• genetics
• eating habits and nutrition
• sleeping patterns
• endocrine function (hormones)
• presence or absence of chronic illness

Each child grows at a different pace and there are different expected patterns and rates of growth during infancy, childhood and puberty. Monitoring of a child's growth will help you and your child’s health-care provider identify slower than expected rates of weight gain and linear growth (growth in length/height). If a child's growth is not monitored closely, growth disorders may be missed. A growth disorder may prevent the child from reaching the optimum height.

Types of growth disorders

Poor weight gain

Poor weight gain is not a growth disorder. It is a label given to children whose weight or rate of weight gain is significantly lower than other children of the same age..

Poor weight gain can be caused by many factors:

• insufficient intake
• increased nutritional needs
• problems with absorption of nutrients

Regardless of its cause, some children who experience poor weight gain may eventually also experience growth problems, such as slow or stalled growth.

Short stature

Short stature is also a descriptive label that refers to children whose height or height velocity (rate of height gain) is lower than other children of the same age. Not all children with short stature have a growth disorder. Short stature can have some of the same causes as poor weight gain. More commonly, it is associated with genetics and not disease. Some children grow more slowly, reach puberty at a later age, and stop growing at a later age and so they reach normal heights. This is called constitutional delay of growth and puberty.

Other children with short stature have parents who are shorter. They grow at the expected rate but are still shorter than other children their age. This may be because they will inherit their parent's final height. This is called familial short stature.

A health-care provider uses the heights of both parents to calculate a projected final height for a child as well as a child’s height velocity to determine if further investigations are needed.

Endocrine diseases

The endocrine system is the body's chemical messenger system. It transports hormones throughout the body. The hormones help regulate processes in the body, including growth. When there is a disorder with the endocrine system, growth can be stunted.

Endocrine disorders include:

• Growth hormone deficiency: This rare disease happens when a child has little or no growth hormone. Growth hormone is made by the pituitary gland. Growth hormone stimulates growth through chemical interactions in the body. Without it, or without enough of it, growth is slowed or stunted completely.
• Hypothyroidism: This is a condition caused by low levels of thyroid hormone in the blood. Without enough of this hormone, babies can suffer from poor brain development. Older children can have slow growth and slow metabolism.

Turner syndrome

Short stature is found in girls with Turner syndrome. Turner syndrome is when a girl is born with a missing or damaged X chromosome. Girls with Turner syndrome are not able to reproduce because their ovaries do not develop properly. They may also show other physical signs.

Signs and symptoms of growth problems

A baby's or child's growth problem can be noted after measurements of length or height show a slower than normal rate of growth.

Other causes of growth problems

Disturbances in health and nutrition almost always affect growth.

Other causes of growth problems include:

• chronic conditions affecting the brain, heart, kidneys, or lungs
• inflammatory bowel disease
• chromosomal abnormalities such as Down syndrome
• Cushing syndrome (abnormally high cortisol levels)
• genetic syndromes

How a health-care provider can help your child

Your child's health-care provider can help by regularly monitoring your child's growth. Proper growth assessment and monitoring includes:

• recumbent (lying down) length from birth to two or three years of age using a measuring board
• standing height for children who are able to stand using a stadiometer (device used to measure height)
• weight
• head circumference until two years of age

Using the weight assessment alone is not helpful. This is because it cannot distinguish a tall, skinny child from an obese or well-proportioned one. Comparing weight and length/height is important in evaluating a child’s growth.

A child who has stopped growing or is growing slowly may need additional testing to determine the cause. Testing may include blood tests, a wrist X-ray, and body or brain imaging to help determine the cause of the growth failure.

Treatment

If a specific disease has been determined, certain treatment options may be available to increase the child's final height. Growth problems due to endocrine disorders like hypothyroidism may be treated with thyroid replacement medication. Growth hormone injections may be provided to children with a growth hormone deficiency or Turner syndrome.

What you can do to help your child with growth problems

Have your child weighed and measured at each of these times:

• within one to two weeks of birth
• at one, two, four, six, nine, 12, 18 and 24 months
• once a year between four and six years

Older children and teenagers should also be measured once each year.

When to see a doctor

All parents should be seeing their child's doctor regularly, but if you discover a sign or symptom that concerns you, see the doctor immediately.

​Virtual care services for children

Boomerang Health was opened by SickKids to provide communities in Ontario with greater access to community-based services for children and adolescents. For more information on virtual care services in Ontario to support issues related to growth, visit Boomerang Health powered by SickKids.