In a ManilaMed Health Line FB Live episode, ManilaMed’s Medical Director and Pediatric Endocrinologist, Dra. Susana P. Padilla-Campos discussed how parents should pay attention to growth problems in their children and adolescents. Although children with growth problems include those who are TOO FAT, TOO THIN, TOO TALL, TOO SHORT, the session focused on SHORT STATURE.

What follows are the salient features of her discussion.

When asked what are the most common causes of short stature,  Dra. Campos explained the many factors that influence and determine the growth pattern of a child or adolescent and enumerated the various etiologies.

There is Normal Variant Short Stature which includes:

Genetic or Familial short stature

Constitutional Growth Delay.

Pathologic Short Stature  on the other hand have various causes:

Disproportionate

–        Skeletal Dysplasia

–        Rickets

          Proportionate

–        Chromosomal abnormalities

–        Dysmorphic syndromes

–        Genetic mutations: POU1F1, PROP1

–        Environmental insults (pre- & post-natal)

–        Chronic systemic illness

–        Drugs

–        Endocrinopathies : Hypothyrroidism, Growth Hormone Deficiency, Cushing’s Syndrome, Pseudohypoparathyroidism, Poorly Controlled Diabetes Mellitus, Hypogonadism

–        Idiopathic Short Stature

In assessing children and adolescents with short stature, the following basic principles must be considered:

  •         Most children with short stature are healthy
  •         Growth failure may be the first and only sign of an underlying health problem
  •         The cornerstone of diagnosing worrisome short stature is accurate anthropometric measurements (height and weight) over time
  •         Delayed intervention may result  in permanent adult height deficits
  •         Major, expensive workup for short stature can be avoided if history (birth history, onset of short stature, frequency of change in shoe and clothes size, past medical illnesses and hospitalizations, use of medications, dietary intake, parental heights and pubertal patterns), review of systems (questions about headaches, blurring vision, breathing problems, heart beat,  bowel movements, urine patterns, energy level, weight change, rashes, bullying etc ) auxologic data (height and weight measurements), PE findings are carefully analyzed and correlated
  •         Growth hormone therapy is extremely expensive, has risks, may have limited benefit and should therefore be used judiciously only for growth hormone deficiency and growth hormone dysfunction, and for conditions that have research-based evidence that it will result in significant improvement in height

The warning signs that  should alert parents that their child may need to see a growth specialist are:

  •         Shortest child in class
  •         Outgrown by younger sibling
  •         Patted in the head and lifted by classmates
  •         No change in shoe/clothes size in 18 months
  •         Early/delayed appearance of pubertal changes
  •         Complaining about his/her height because of functional restrictions or bothersome teasing or bullying
  •         Getting into fights or becoming withdrawn

Sometimes though the child is healthy and well-adjusted but:

  •         Parents are inordinately concerned about their child’s height

When being evaluated for short stature,  the following findings increase the chance that there is a REAL growth problem:

  •         History of  Intrauterine growth retardation, Small for gestational age
  •         Presence of dysmorphic (unusual facial) features
  •         Presence of dermatologic signs
  •         Associated with obesity
  •         Associated with headache, blurring vision, vomiting, sexual precocity or arrested pubertal maturation, syncopal episodes or seizures, behavioral changes, weight loss
  •         Deceleration in linear growth

After obtaining the history and doing a complete physical examination, evaluation should be directed at establishing a diagnosis, and not get a whole battery of unnecessary tests

  •         Laboratory Tests

–        Initial Screening

  •         CBC, ESR
  •         Chemistry panel
  •         Urinalysis
  •         T4 and TSH
  •         Bone age

–        Specialized Studies (based on a high index of suspicion for a particular condition)

  •         Karyotype
  •         Anti-endomyseal or anti-gliadin antibodies
  •         8am cortisol level
  •         GH stimulation test
  •         IGF-1 & IGFBP3
  •         Head CT or MRI

Management of Growth Failure

  •         Tincture of Time is most important  for adequate growth monitoring
  •         Specific treatment is based on the diagnosis
  •         Nutritional up-building for under-nutrition
  •         Growth Hormone for Growth Hormone Deficiency, Turner Syndrome, Chronic Renal Failure,  Prader Willi Syndrome, Noonan Syndrome, Small for Gestational Age Newborns, Idiopathic Short Stature
  •         Thyroid Hormone for hypothyroidism
  •         Sex steroids for delayed adolescence
  •         Discontinuing offending drug
  •         Psychological Support

Dra. Campos reminded parents about the value and importance of plotting height and weight  measurements on a growth chart. They should always ask their child’s Pediatrician to show them the Growth Chart where  one can easily visualize if their child is growing at a normal or abnormal rate. Any deceleration or crossing at least 2 lines, deserves a referral to  Pediatric Endocrinologist.