Growth problems: Measuring up

Growth problems are explained by doctors at Great Ormond Street Hospital, in our A to Z series on health

Growth delay can occur in children, but is rarely a sign of a serious underlying problem. From the age of two onwards children tend to grow at a fairly steady rate of around five to seven centimetres a year. This changes at puberty when there will be some growth spurts.

Growth delay often runs in the family where it is experienced by a parent or sibling. However, just because a child is small doesn't necessarily mean that they have a disorder. Only a small proportion of children whose growth is delayed will have an underlying growth condition. Any child on chronic treatment for an underlying disease is also more likely to experience growth delay. However, once the underlying condition is brought under control normal growth should resume.

Should all children undergo growth assessments?

There are several factors which can influence a child's growth. It is therefore vital to ensure that every child undergoes regular growth assessments to see whether there is an underlying problem that might require investigation. As part of this it is also important that an accurate background is provided, which should include:

• Birth weight and length
• Pre- and postnatal complications
• Developmental milestones
• Eating patterns
• Illnesses and operations
• Medications
• Behavioural or emotional problems
• Family history and parental height measurements.

What causes slow growth rate?

In the first two years of a child's life growth is primarily dependent on nutrition. From then on it is influenced by factors ranging from a genetic predisposition and hormones to diet, health and social and economic influences. Growth problems may be due to:

• Genetics (familial short stature). Parents who are both short tend to have shorter children. These children will still experience growth spurts but their genetic height is inherited from both parents.
  
  
• Constitutional growth delay. This term applies to children who are small for their age. These children do not have any diseases that affect growth. They will grow at a slower pace but ultimately reach their adult height at a later age than their peers.
  
  
• A medical condition. Studies have shown that growth can temporarily slow down during any illness. Minor childhood diseases requiring antibiotic treatment such as middle ear infections and measles can temporarily slow down the pace of growth.
  
  
• Isolated Growth Hormone Deficiency. Some children will have an isolated problem with producing growth hormone. This can be tested for by a specialist team following a referral to an endocrinologist.
  
  
• Smoking during pregnancy. Many studies have shown that women who smoke during pregnancy may give birth to smaller babies. While it is common for newborn babies to lose a little weight in the first weeks, some infants can continue to grow at a slower rate then anticipated. This is usually caused by inadequate nutrition or feeding problems. However, it may also be a symptom of other problems such as infection or digestion problems.

Evaluating growth problems

If you are concerned, arrange for the child in your care to be seen by a local health visitor or doctor. They will monitor weight and height and decide whether the child's size or growth curve is a cause for concern. Depending on the findings, a referral may be made to an endocrine specialist.

Treatment

If an underlying endocrine condition is identified, then replacement hormone therapy may be suggested. For children with growth hormone deficiency, growth hormone injections may be used.

Remember

It is always a good idea to ensure that a child's growth is regularly checked using the correct charts. Early detection of abnormal growth patterns through this method, combined with accurate record taking, can play a crucial role in indicating an underlying condition. If there is any concern about a child's growth pattern professional help should be sought.

Information leaflets entitled Your child's growth and centile charts are available from the Child Growth Foundation, 2 Mayfield Avenue, London W4 1PW. You will need to state the child's sex and include an SAE and four first class stamps.