A pediatrician does certain things at every well-child visit to check on a child’s development. Measuring height is one of them. How quickly and how much a child grows is individual and depends on many factors. However, if your child seems to be displaying slower-than-normal growth, it’s natural to be concerned. You may be wondering what it means and what you can do to help your child grow.
The good news is that most kids who are short for their age have no medical issues and are healthy and growing normally. If that’s not the case, your pediatrician can help identify any underlying issues and guide your next steps.
How pediatricians assess a child’s growth
Physicians monitor and evaluate a child’s growth in several ways, including:
- Growth chart: Tracking your child’s height on a growth chart is the standard way to monitor their physical development. The chart’s percentile lines depict an average growth path for a child according to their age and sex. When the pediatrician adds your child’s height to the chart each visit, it provides a visual summary of your child’s growth over time and suggests how your child’s size compares to others of the same age and sex. Short stature is when a child’s height falls at the third percentile or less — meaning that approximately three out of every 100 children of the same age and sex are shorter.
- Bone age: Pediatricians can measure your child’s left hand and wrist with a radiograph (X-ray) to assess their bone age. The assessment reveals whether your child may still be growing and can help predict how tall a child will be as an adult. Once a child finishes growing — displaying a bone age of 16 years in males or 14 years in females — no interventions can further help with growth.
If your child falls below the third percentile or is suddenly not growing at the same rate, a blood test can assess for growth hormones and diseases or disorders known to affect growth.
What can cause short stature in children
Slow or stalled growth may be a sign of an underlying medical issue, but most short kids are healthy and growing fine. According to the American Academy of Pediatrics, short stature that is not associated with a medical problem may be caused by:
- Familial short stature: One or both parents are short, and the child’s growth rate is normal.
- Constitutional delay in growth and puberty: The child is likely a “late bloomer” who has late-onset puberty but will grow later and reach a typical adult height range.
- Idiopathic short stature: There’s no identifiable cause for the child’s short height, but the child is growing and healthy.
If your child has an underlying issue affecting their growth, there may or may not be other noticeable signs and symptoms. Medical conditions that can affect growth include:
- Chronic medical conditions, including heart disease, gastrointestinal diseases and bone disorders
- Hormone-related conditions, such as hypothyroidism, growth hormone deficiency, diabetes or Cushing’s disease
- Genetic conditions, such as Down syndrome or Turner syndrome
- Poor nutrition, which may hinder bone and muscle growth
- Small birth size, including weight and length, for gestational age
- Medication, including some drugs used to treat attention deficit hyperactivity disorder (ADHD) and asthma
If the pediatrician suspects an underlying medical issue, they may refer you to a specialist or order further testing.
Growth hormone injections and treatment for short stature
Not all children with short stature need medical intervention. If your child’s pediatrician attributes their height to their family stature or delayed onset of puberty, they’ll likely keep a close eye on your child’s growth. Children with an underlying chronic disease will require disease management.
For some children with idiopathic short stature, hormone-related issues or genetic conditions, growth hormone (GH) supplementation may help kickstart growth. GH is made in the pituitary gland and affects bone growth, muscle mass development and height. If tests confirm that your child’s body isn’t producing enough, your pediatrician may advise you on FDA-approved injections containing synthetic GH. GH treatment is also approved to help stimulate growth in children with some other conditions causing short stature, such as Turner syndrome.
Each child’s growth and development is individual, and so is the decision to pursue treatment for short stature. However, it’s always a good idea to bring your concerns to your pediatrician’s attention. Your child’s height may be affecting their mental health, and slow or stalled growth may be the first sign of an underlying medical issue. Your child’s physician knows your child’s history and is the best person to address those concerns.
