Growth is the work of childhood. Poor growth may be an indicator of an underlying problem and should be investigated and the cause treated as soon as possible. There are many causes of poor growth, some permanent and others transient. Short stature out of keeping with that of the family, or where a child fails to grow along their growth percentile when plotted on a growth chart warrants further investigation.
A child’s estimated final height can be gauged from their parent’s heights. To calculate this mid-parental height (MPH) add the father’s height in centimeters to the mother’s height in centimeters and divide by 2 to get the average. To calculate the MPH for male children add 6.5cm and for female children subtract 6.5cm from the average of the parent’s heights.
The most common cause of poor growth is genetic short stature usually one or both parents are short. Constitutional delay in growth is the second most common cause. These are typical “late bloomers” who will show some degree of catch-up growth during puberty. However if growth or stature is a concern it is best to investigate well before puberty rather than waiting for the pubertal growth spurt that may well not arrive or be inadequate to achieve normal catch-up growth.
Growth hormone may be required in some children to achieve a height within the adult normal range, and is given by daily injection. Because of the expense of growth hormone a thorough evaluation by a paediatric endocrinologist is required before growth hormone can be recommended and therapy is often carried out by or under the supervision of such a specialist. The most commonly prescribed growth hormones are Norditropin Nordilet and Humatrope.
The rule of thumb is that the earlier growth concerns are tackled the better the outcome.
Tall stature or excessive growth may also be an indicator of an underlying disorder and warrants investigation. Sometimes growth attenuation therapies are required to limit final height in both boys and more commonly in girls.
The earlier growth disorders are detected and therapies instituted, the better the outcome. A common pitfall is to wait for a pubertal growth spurt that does not occur.