Every few weeks I interact with worried parents who come to me with complaints of their child not growing enough or not having achieved the right height and weight. In the last decade of my practice as a paediatric endocrinologist I have seen growing number of such cases, where the child has entered well into their teens and are still of a short stature. 

Growth, as most parents and doctors would put it, is a natural process that occurs in a child since birth. Some children grow faster than others, some grow at a slower pace. But at the end of the day, the child must grow. 

Infants generally grow up to 25cm in the first year of their life. As they mature into toddlers, they grow up to an additional 10cm between ages 1-2 and up to 7.5cm between ages 2 and 5. From ages 5 onwards, until a child reaches puberty, an increase of up to 5cm in height each year is seen in most children. 

These are the height milestones that a child must achieve to attain their full growing potential. If due to unforeseen circumstances, the child is not able to meet these requirements, parents should consult their paediatrician/family physician to understand the causes behind their child’s stunted growth. 

Breaking Myths Related to Growth

I often get asked several questions about the height and the weight of a child. Some parents claim to be on the shorter side and thus, assume that their child will be short too. Others believe that their child does not eat well and is therefore not growing adequately. Yet there are others who say that their child will shoot up when the ‘time is right.’

But it is important for parents to understand this - growth does not work that way. While genetics does play a role in determining the average height of a child, it is not the only factor. Irregular growth patterns in your child is actually an indication that something is wrong with the child’s metabolism.
Importance of Growth Hormones

Everything from proper nutrition, environmental wellbeing and an active lifestyle contributes to a child’s overall growth and development. Make sure that your child is having a well-balanced diet, is sleeping for at least 10 hours a day, is involved in sport activities and indulges in regular conversations with those around him or her. If despite these reasons, you do not see your child hitting the regular growth chart; it could be due to a medical condition such as Turner’s syndrome (only for girls) or a deficiency of growth hormones.

Growth is a complicated process that involves the participation of several hormones or chemical messengers. Growth hormones are responsible for the adequate growth of organs, muscles and bones and are produced in the body by the pituitary gland, which is a small organ located near the brain. Once this hormone is secreted into the bloodstream, it travels to different parts of the body and initiates the process of maturation and growth.

Growth Hormone Deficiency - What You Need to Know

In some cases, the pituitary gland fails to produce enough growth hormone which leads to stunted growth in the child. The medical term for not having enough growth hormone is called as ‘growth hormone deficiency. (GHD)

Sometimes GHD can occur from birth itself. Congenital GHD generally occurs due to abnormalities in the pituitary gland or due to the occurrence of other anomalies. In other instances, GHD may be acquired at birth due to trauma, infections, decreased oxygen supply to the brain, tumour formation in the pituitary gland and other systemic diseases that affect the production of growth hormone in the body. 

Irrespective of the occurrence, the symptoms exhibited by patients with GHD remain the same. Children with GHD fall below the normal height range and often have a layer of fat around their abdomen region. While there is no evidence that says that a lack of growth hormone can affect the IQ of a child, children with GHD may have problems with cognition, have lower self-esteem as compared to their peers and can exhibit various psychological problems such as poor memory, anxiety and lack of concentration. They are sometimes subjected to ridicule due to their short stature which causes their confidence to drop further. 

In severe cases of GHD, other physiological complications can also be seen. GHD in children can be diagnosed by a paediatric endocrinologist who will perform several blood tests and carry out measurements and calculations that will confirm that the irregular growth seen in a child has indeed occurred due to the deficiency of the growth hormone. As parents, you must carry out regular (at least twice a year) measurements of your child’s height and weight. If you notice any discrepancies in growth patterns, consult your doctor immediately. Early diagnosis in GHD can go miles in determining the correct treatment protocol and increasing the chances of the child to gain back his or her optimum growth. 

Growth Hormone Therapy Can Help in Cases of GHD
The only treatment for cases of GHD is growth hormone replacement therapy. The treatment constitutes of injecting a synthetic growth hormone into the body that makes up for the lack of naturally produced growth hormone. Injections for growth hormone need to be given daily to the child until they reach puberty and no further bone growth can take place. 
Growth hormone therapy has proven to be a safe and effective treatment method and if started early, a child receiving growth hormone will grow just like any other child. Sometimes, minor side effects are seen with the therapy such as reddening at the site of injections and headaches. But these are not long term effects and are not much of a reason to worry. 

Ready, Get Set, Grow!

The best way to ensure that a child’s overall growth is well monitored is to empower parents with the right knowledge and tools for doing so. As parents, it is necessary for you to be well informed so that you can make better decisions for your child. Ready, Get Set, Grow! is a recently published book by myself and my colleague Dr Azriyanti  Anuar  Zaini that explains the basic concept of growth in a language that both parents and children can understand. You can access the book at all major public libraries as well as online, where the book is available free of cost. 
Ultimately, do not take the growth of your child lightly. Growth is an important milestone that every child must achieve for a smooth ascend into adulthood. Irregular growth patterns are often warning signs that need attention and you should bring these to the light of your consulting paediatrician as early as possible to ensure that your child grows well and strong. 

What’s Normal

       Age                                          Height
0 – 12 months                                Up to 25 cm
1 – 2 years                                     Additional 10cm
2- 5 years                                       Additional 7.5cm
5 year onwards                              Additional 5cm each year till puberty



About The Author:
Associate Professor
Dr. Muhammad Yazid Jalaludin is theHead of Department of Paediatrics, Faculty of Medicine, University Malaya.He is currently the President of the Malaysian Paediatric Association (MPA), Vice President of the Malaysian Endocrine and Metabolic Society (MEMS) as well as the President Elect of the Asia Pacific Paediatric Endocrine Society (APPES). He is also a member of the Academy of Science Obesity Task Force on Prioritizing Food Policy Options to Reduce Obesity in Malaysia and also a member of the Malaysian Association on the Study of Obesity (MASO). His main research interests lie in growth (Nutrition), obesity and type-2 diabetes mellitus, and vitamin D in children.