Is my child short?

Height is more than just a number. It could be a strength to few, but a weakness for some.

The height of a child scares few parents, while some experience pride. 

For the young ones, being tall may bestow a sense of power. On the other hand, being short is cute and attracts admiration. For a few, of course, it is a hindrance to their self-confidence.  

For me as a pediatrician, height is a reflection of how well or ill the child is. 

I often see kids being brought by the parents with a concern of being short or not growing well. 

On one end are those parents who panic regarding the child’s growth and keep pestering the doctor to prescribe supplements, appetite boosters, or growth enhancers. 

Contrary to these, certain kids are brought by their well-informed relatives, after years of ignorance by the parents, while few others are brought for evaluation at an age when nothing much can be done. 

So quite clearly, there is a lack of awareness about what normal growth in a child is and when the parents should be concerned. 

So here I present a few facts regarding a child’s growth that every parent must know.

What is growth?  

Growth refers to an increase in the size of the body and is marked by an increase in the weight and height of an individual. 

The thing that characterizes childhood apart from the innocence and the lack of inhibitions is the continual growth of the body

Normal height is a sign of physical and mental well-being of a child. 

Until when does a child grow?

Growth is a process that begins before birth and is visible from the newborn period until a variable period into adolescence. 

An increase in the height continues until the fusion of growth plates occurs (these are the cartilages present at the ends of long bones). It is through the deposition of new cells at these growth plates that there is an increase in the size of the long bones and thereby gain in height.

What is the normal pattern in which a child grows?

The growth rate is maximal after birth, in the first year of life, and then gradually declines, until about 5 years of age.

The rate then remains steady at a rate of 5-6 cm/year for the next few years until the onset of puberty. 

(Puberty is a phase of life where sexual maturity occurs. The onset is marked by breast development in girls and testicular enlargement in boys. Generally, puberty begins between the ages of 8 to 13 years in girls and 9 to 14 years in boys).

As the child enters into high school, a spurt in the height may be noted, which corresponds to mid puberty. The height spurt in a girl occurs just before the onset of menstrual cycles.

What are the factors that influence the height of the individual?

The height of a given child is determined by age, gender, race, and genetics, i.e the parental height.

Adequate nutrition, exercise, sleep, physical and mental well-being, a normal hormonal milieu ensures that the child grows normally

Physical well-being implies a disease-free state. 

Growth is an active process that requires energy. Since growth is not absolute for survival, when the body is under strain incurred by prolonged illnesses, growth becomes a lesser priority. To conserve energy to sustain life, growth takes a back seat and the height gets compromised. Besides, certain medications consumed by the child for chronic illnesses can negatively affect growth.

What is short stature?

Short stature is typically defined when a person’s height is less than the third percentile on the growth charts.

In simple terms, when the height of your child is less than the normal expected for his age and gender, he/she is said to be short.

Or

When your child does not grow at the pace which is expected for his/her age and gender.

Or

When the child is growing apparently normally but is short for the height of the parents.

This is evident when the doctor plots the height of the child against the age in the respective growth charts. 

Growth charts are a graphical representation of a child’s height against his/her age. There are different charts for the boys and the girls. 

The growth of Indian children is plotted on the IAP (Indian Academy of Pediatrics) growth charts, which are generated from studies conducted on our population.

What causes short stature? Why should you worry about your child’s height?

Short stature is not an illness in itself but may be a sign of an underlying morbidity. There are two types of short stature. 

Physiological: This does not indicate any grave underlying illness. 

It could be familial (due to short parents) or constitutional (ie when the child is shorter than his/her peers but growing at the normal pace; the growth then catches pace with onset of puberty, to reach the normal adult height). 

Both familial and constitutional short stature are considered normal variants of short stature. 

Pathological: These are the conditions, wherein the height is compromised due to underlying major illness. The illness can be anything viz nutritional anemia, kidney failure, chronic infection like tuberculosis, or endocrine disorders like hypothyroidism or growth hormone deficiency, to name a few.

Though a person is not defined by his/her height and appearances, height certainly forms a part of an individual’s personality, 

But, more importantly, poor weight gain or height gain may reflect an underlying illness. Hence it is important to pay attention. 

Often diseases manifest with symptoms like loose stools, bloody stools, headache, weakness, deformities in limbs, pain abdomen, etc. But in a substantial number of cases, the disease may be asymptomatic and the only manifestation may be short stature. 

Recently, I saw an 8-year-old female child who was 94 cm (about the age of 3-year-old child). Though the parents felt the child was short, they dint think it was as serious. They had consulted a local doctor in the village about a year ago and were only reassured. After evaluation, we diagnosed the girl with a condition called renal tubular acidosis and started her on treatment. Her general condition improved and she is now growing well. 

When should you suspect your child is short?

Many parents worry that the child does not eat well, is not growing well, or is not gaining enough weight. 

Often the reason for the parents’ concern is the child being the shortest in his/her class. In most cases, the parents raise a false alarm about their child’s improper growth. 

The simple question to ask oneself is if the child can reach objects and places vertically that he was not reaching earlier. Is he /she outgrowing clothes and shoes every year? 

If the child is performing well in studies and other activities, not having any obvious health concerns, you may be reassured that there is not a big thing to worry about. 

As a rough guide, an average child is 75 cm at 1 year of age, about 105 cm at 5 years of age, and about 135 cm at 10 years of age.

The following must alert the parents to consult the doctor…

  1. When the younger siblings outgrow the height of the child in question.
  2. When you feel the child is remaining of the same height over years, as perceived by the things he can reach at home or the clothes not falling short with age.
  3. If the child has issues with the intake of food or has other features like falling ill recurrently, pain abdomen, frequent loose stools or headache or any particular symptom, you may want to consult a doctor once.

What does the pediatrician do in a short child?

First of all, the correct measurement of height is of utmost importance.

The pediatrician measures the child’s and parents’ height and plots it on the growth chart. The growth charts provide a visual depiction of where the child’s height lies and how the child is growing. 

If short stature is detected, the doctor does a detailed evaluation, including a detailed history and physical assessment. A set of blood and urine investigations may also be ordered, in a step-wise manner to look for an underlying illness. 

After finding the cause of short stature, appropriate treatment is initiated. 

Which child benefits from treatment with growth hormone?

I have encountered few parents, who are short as compared to their friends and family members. Having faced disrepute at school, job, or relatives, they often insist on doing everything possible so that the child does not end up being short, including considering treatment with growth hormone. 

Any given child grows according to his/her genetic potential and no medicine including growth hormone enables a child to outgrow his/her potential.

It is important to understand that the Growth hormone is not a magic drug that can make any child tall. It is prescribed only for certain approved conditions, like growth hormone deficiency due to a pituitary defect and a few others. 

I conclude this post by laying emphasis on being aware and alert about how your child is growing. Apart from your assessment, it is essential to monitor the child’s growth by routine check-up with the pediatrician and plotting your child’s height on the growth charts annually.

Thank you for reading through till the end of this post. If you have any queries, post them here. Do not hesitate to leave your comments.

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