Dr Warren Lee, MBBS, M Med (Paeds), FRCP (London), FRCPCH (UK), FAMS

Do you suspect that your child too short, too fat, too thin, going into puberty too fast or that puberty is overdue and nothing is happening? Does it seem as if your child's growth has peaked some time ago and is slowing down, but he or she is still short compared to friends of the same age? If so, read on....

Many foods, vitamins, supplements and milks have been put forward as the answer to poor growth in childhood. But it is not always about nutrition. It is not always true that skipping and playing basketball will help you to grow taller. Neither is a wait-­‐ and-­‐see approach always the correct one.

Some children will never reach their target height without intervention, and if you wait too long the opportunity may be forever lost, because a person will no longer be able to grow taller once the bone ends (epiphyses) have fused.

Many factors affect growth. They include:

Severe growth hormone deficiency from birth is relatively rare, but growth hormone production and release can be affected by low thyroid hormone levels, severe nose allergies, poor sleep patterns and chronic emotional distress, neurosurgery or radiation therapy.

Sometimes, a child could not grow well, not because of a lack of growth hormone, but because of a defect of the hormone receptors or a defect in the bone which prevents a proper growth response (eg achondroplasia, hypochondroplasia).

Growth failure may also occur due to calorie requirements not being met at the appropriate time. In poor countries, lack of food intake is the most common cause. Children with severe asthma would expend more energy on breathing through obstructed air passages. A child with a hole in the heart needs more energy to pump blood through a leaky heart.

There are several stages of growth. Firstly there is the stage of growth in the womb, then growth in infancy, growth in puberty, and finally the growth spurt of puberty which ends when the bones have fused.

A child born premature or born smaller than expected for the period of mother's pregnancy (ie small for gestational age) may not be able to achieve a normal adult height, if adequate catch-­‐up growth has not occurred by age 2 years. A child with untreated celiac disease (gluten enteropathy) cannot absorb nutrients properly, and while catch-­‐up growth occurs after a gluten free diet, the period available for catch-­‐ up may be insufficient to ensure normal adult height. 

If a girl gets her menses early, her bones may also finish maturing earlier, limiting the time available for height growth, and leading to a short adult height. Similarly, boys who achieve their growth spurt too early may be tall compared to their friends while in primary school and in Secondary 1 to 2, but they may eventually end up as short adults.

Growth Hormone treatment is effective when the body's own supply of growth hormone is insufficient or absent, and in cases where the body's response to growth hormone is impaired but not absent (eg Turner's Syndrome), or when a prior medical condition has led to growth failure (eg Small for Gestational Age children).

Growth hormone can only be given by injection, and should only be used under medical supervision, by a physician experienced in the use of such medications in a paediatric setting. Growth hormone will not work when the bones have fused.

In conclusion, a child who is shorter than his or her peers, or whose growth is much faster than his or her peers, should be evaluated without delay by a doctor experienced in these matters. This would allow the detection and treatment of underlying conditions which could impair growth, as well as an objective evaluation of the suitability of growth hormone use.