‘Short’ is not always ‘Sweet’ Learn about Short Stature in Children

As a parent, have you ever been concerned that your child is ‘too short’? You are not alone in worrying this way. Parents complain that their children have not grown adequately when compared with other children of their age. Such children being among the shortest in their class is a common presentation in paediatric practice. To educate the reader about this aspect of health concerns we decided to consult Dr. Deepal Perera, Consultant Paediatrician, Lady Ridgeway Hospital for Children. Dr. Perera spoke about the short stature in children, its causative factors and management options in an interview with health capsule.

Short stature in a child can be due to various causes. These causes can be due to illness, but more often it is due to normal genetic makeup of the child.

Normal growth 
Talking about the height of the child, a child usually inherits his height from his or her mother and the father. So, a child born to a couple who are relatively short in build, is likely to be short as an adult, himself. Similarly, if one parent is short and the other is tall, the child is likely to be of average height. 

Males are generally taller than females, but with small children, girls are usually taller than boys. The highest rate of growth is present during the first year of birth followed by the growth spurt in adolescence. The rate of increase in height considerably lowers after a girl attained her menarche, while a boy keeps growing until he is around 18 years of age, causing them to attain taller statures in the end. 

Causes for short stature
In the condition called familial short stature, a child is short because his genetic makeup has predetermined him to be short. His parents are likely to have shorter statures as well. In case the child is diagnosed as having familial short stature, there is no need for concern because the child is completely healthy despite his lacking in height. 

In another common condition called constitutional delay in growth, the child will gain a more average height, but his rate of growth is slow when compared with other children. He will likely experience a rapid growth spurt after reaching adolescence, requiring no medical interventions. 
 Chronic malnutrition can present as short stature, along with low weight for age. 

Short stature can also be the first presentation of other underlying disease conditions. Conditions like Cushing’s syndrome where the body has abnormal production of corticosteroid can present as short stature. In addition, some individuals with congenital abnormalities like Down Syndrome and Turner Syndrome also can have relatively short heights. 

Hormone deficiencies also can contribute to a short stature. In the first two years of life, the hormone thyroxine controls the rate of growth of the child. The release of thyroxine, which is secreted by the thyroid gland in the neck, is controlled by Thyroid Stimulating Hormone, produced in the brain’s anterior pituitary gland. This hormone, in turn, is controlled by Thyroid Releasing Hormone secreted by the hypothalamus. Therefore a defect in any of these areas causing reduced secretion of these hormones can cause reduced rate of growth.

Two years after birth, it’s the growth hormone, secreted by the pituitary, which mainly controls a person’s growth. Deficiency of the growth hormone will also result in short stature in children.

In addition, children having chronic diseases like diabetes mellitus, asthma or heart diseases can have short stature if the disease condition is not managed properly. It has also been found that children who have been psychologically deprived through negligence, abuse etc also tend to have shorter stature when compared to their peers.

Investigations 
Most of the children who present to those involved in paediatric practice  with reduced height belong to the first two categories mentioned above and require no interventions, explained the doctor. But, it is necessary to examine and assess each and every child carefully in order to exclude rarer causes for short stature, which may be correctable with timely interventions. 

When a child complaining of short stature presents to the clinic, he is assessed with a detailed medical history, starting from when the mother was pregnant, moving on to the height of the parents, whether the parents were small as children and gained height later on, chronic illnesses in child and dietary history etc. All these have an effect on the child’s height. 

The child’s height, weight as well as the circumference of his head are measured. These figures are plotted in the charts given in the child health development record of the child and compared with the previous values as well as the normal values for his age and build. 

If deemed necessary, investigations are ordered. These include basic investigations like Full Blood Count, Urine Full Report and Urine Culture. X-rays of the hand and the wrist are taken to approximate the bone age. Bone age is delayed in conditions like hypothyroidism, growth hormone deficiency and constitutional delay in growth.

Depending on these findings, the doctor may decide to proceed with further investigations like hormonal assays and even CT and MRI to exclude the possibility of there being a tumor in the brain.

In older children, assessment of features of puberty, pubic and axillary hair growth and the development of genitalia is done along with tests to determine testicular and ovarian functions.

Treatment
If the child is diagnosed to have a treatable condition, he is treated accordingly. Children with growth hormone or thyroid hormone deficiencies will be prescribed relevant hormones from the outside into the body.  Children having conditions like recurrent urinary tract infections are treated with antibiotics. Children with nutritional deficiencies would be given supplementation if necessary.

Tall stature can be bad too
While short children may have underlying medical conditions, children who are excessively tall also may have certain clinical conditions. Some examples are Marfan Syndrome and excessive secretion of growth hormone. Since these conditions also carry other co morbidities, it’s important to asses children who are excessively tall or grown, as well, stressed Dr. Perera.

Message to parents
Shortness is not always due to a disease or an illness of the body. Each of us are different in height, skin colour, consistency of hair etc. and these individual qualities enable the process of evolution to continue. Therefore, shortness may be a part of an individual’s unique genetic makeup. But, there are many treatable causes for short stature and other diseases which present as short stature as well. Therefore, if you are concerned about your child’s height, taking him to the paediatric clinic at the nearest hospital and getting him assessed by a medical personal, will aid in relieving much of your worries.