Pediatric Growth Disorders
Growth disorders are problems that prevent children from achieving normal height, weight or sexual maturity. Just because your child is not developing at the same rate as peers is usually not a cause for concern. Some children may be small for their age but still develop normally. Some kids are short or tall because their parents are, while others mature at different rates.
At Children’s Health℠, we work closely with both you and your primary care provider so that everyone involved has the information they need to create the best outcomes for your child.
Short stature is when your child is significantly shorter than kids of the same age and sex. This is usually due to a family’s genetic makeup and is not considered a growth disorder. Short parents tend to have short children.
Constitutional growth delay occurs when kids are small for their age but grow at a normal rate. These children tend to reach puberty and other developmental milestones later than their friends. Because they also grow until an older age, they usually catch up with peers. These “late bloomers” do not have a growth disorder either.
Some children, however, do have growth disorders. Very slow or very fast growth can signal an overactive or under-active gland or another disease. Symptoms of growth disorders include the following:
- Your pediatrician has most likely plotted your child's growth on a growth chart since infancy. Children who are at or below the 3rd or at or above the 97th percentile on the growth chart may have a growth disorder
- Your child grows less than 2 inches per year after reaching the age of 3
- Your child is much shorter than peers of the same age and gender
- Your short child may be "chubby," with otherwise normal proportions
- Your child's face may look younger than other kids of the same age and gender
- An older child reaches puberty much later than peers (or at all, depending on the disorder)
- A failure to thrive may also be a sign of an underlying growth disorder
Puberty & Sexual Development
The gonads are the main source of sex hormones in both males and females. In males, they are called testes, which secrete androgen hormones such as testosterone. In girls, the ovaries produce eggs and secrete hormones including estrogen. Normally, these hormones help regulate the body changes associated with puberty. Sometimes, a lack or abundance of these hormones can either delay or accelerate puberty and growth.
- Delayed puberty is defined as the lack of any signs of puberty by age 14 in either sex. Most often, delayed puberty is a result of constitutional growth delay. Sometimes, a medical condition can delay puberty. Chronic illnesses such as diabetes, cystic fibrosis, kidney disease or asthma can all cause puberty to occur later on. Malnourished kids may have delayed puberty as well.
- Precocious puberty is when there are signs of secondary sexual maturation before 8 years of age in girls and 9 years of age in boys. In girls, signs of precocious puberty might include breast growth and a first period. Boys may have enlarged testicles and penis, facial hair and a deepening voice. Both boys and girls both may have pubic or underarm hair growth, acne, and body odor as well. Causes might include ovarian cysts in girls and certain tumors in both girls and boys. Exposure to certain creams and ointments containing estrogen or testosterone might also trigger precocious puberty.
The endocrine system is made up of glands that secrete hormones into the circulatory system. If something goes wrong, it can affect a child's growth. Endocrine disorders associated with growth include:
- Growth hormone (GH) deficiency occurs when the pituitary gland doesn’t secrete enough GH. Without enough GH, a child is likely to grow slowly and be much shorter than other children of the same age and sex
- Hypoparathyroidism is a calcium disorder related to the parathyroid. The parathyroid makes parathyroid hormone (PTH), which helps balance calcium and phosphorous in a child's body. Hypoparathyroidism can lead to juvenile osteoporosis and delayed growth
- Hypothyroidism, or an underactive thyroid, occurs when the thyroid (a gland located in the neck) doesn’t produce enough of certain hormones. As with hypoparathyroidism, it can cause delayed growth in kids.
Congenital disorders are those present at birth. Many congenital growth disorders are genetic and include:
- Congenital adrenal hyperplasia, which prevents the body from making enough cortisol. Children born with congenital adrenal hyperplasia may have other hormone imbalances that affect growth.
- Turner syndrome, which is a genetic disorder that occurs in girls. Girls with Turner syndrome are short and usually have an abnormal puberty.
- Klinefelter syndrome occurs when a boy is born with an extra Y-chromosome (boys normally have one X- and one Y-chromosome). Boys with Klinefelter syndrome may have long legs and a short trunk, along with some sexual symptoms.
- Androgen insensitivity syndrome (AIS) occurs when a child has one X- and one Y-chromosome, as a boy does, but the body doesn’t process, or is resistant to, male hormones. This results in a child with mostly female physical characteristics, but the genetic makeup of a male.