My Child Is Short

September 16, 2014
One common concern among parents is that their children seem smaller than other children of the same age. In this article, we look at the causes and treatments of short stature in children to help parents understand the issue and raise their children to grow up healthy and happy.
First of all, it is important to understand that what parents often consider to be short may not necessarily be classed as short in a medical context. Short stature in a child is typically defined as a height that is 2 standard deviations (SD) or more below the mean height for individuals of the same sex and age in a given population. 
The growth chart is used to assess whether a child’s growth rate is below the average, the child is growing more slowly than the average, or the child has stopped growing altogether. Generally, there are 3 stages of childhood growth as follows:
  • Infancy and Early Childhood (0-2 years): The growth rate is between 30 and 35 cm.
  • Middle Childhood: The growth rate is between 5 and 7 cm per year.
  • Adolescence: The growth rate is between 8 and 14 cm per year.
There are many causes for a child to have a short stature. It may be the result of a growth pattern inherited from a parent (familial short stature) or simply a case of delayed growth and puberty (constitutional delay of growth and puberty). Neither of these cases is considered a disorder and no treatment is required if the child is otherwise healthy.
Causes that do require treatment include the following:
  • Early puberty: If puberty begins before 7-8 years for girls (breast development, onset of menstruation) and 9 years for boys (hair development, acne, body odor, voice deepening, rapid height growth), it is classed as early puberty. This will cause an early growth spurt that will make the children initially tall. However, because early puberty also ends earlier than normal, the children will stop growing at an earlier age and be shorter as adults.
  • Hormone disorders
    • Growth hormone deficiency: The cause of growth hormone deficiency must be determined and treated immediately.
    • Thyroid hormone deficiency
    • Vitamin D deficiency (rickets) or vitamin D resistance
  • Other known causes
When consulting a doctor, parents should bring their child’s growth chart with them as the doctor cannot diagnose a growth problem from current height only. A bone age x-ray of the child’s hand and wrist is used to help the doctor assess whether the child’s bones have matured and grown at an age-appropriate rate. From this, the doctor can predict the child’s final adult height. In some circumstances, a blood test is also required to help identify the causes of short stature. 
Once a growth problem is diagnosed, the doctor will select the most appropriate treatment according to the cause. Treatment options include growth hormone injections, early puberty medication, thyroid hormonal therapy, and vitamin D therapy. However, all treatments should only be administered under a doctor’s supervision, especially growth hormone injections. 
As always, prevention is better than cure and you can help promote your children’s growth by providing nutritious foods from all groups and making sure that they exercise regularly and get enough sleep. If you are concerned about your children’s growth, please consult a pediatrician. 
In some cases, your child may be shorter than you expected, but otherwise perfectly healthy with no disorder. In these cases, you should help your child feel good about him or herself by pointing out your child’s strengths and not focusing too much on his or her height. Being short isn’t usually a problem for children and doesn’t keep them from having a normal, happy life.
By Dr. Nipapat Visavachaipan, pediatrician specializing in endocrinology and diabetes, Children’s (Pediatrics) Center, Bumrungrad International Hospital, Bangkok, Thailand
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