Is Growth Hormone Deficiency The Culprit Of Your Child’s Shortness?

Children grow at different rates – while some are tall, others are shorter. This is usually normal. But do parents know that being too short could be a sign of a significant health problem?

Having short parents is one of the most common reasons of a child’s short stature. However, if your child is not growing as fast and as tall as other children their age, there is a chance where stunted growth may be the culprit of their short stature.

The World Health Organization (WHO) categorizes children who are stunted as those whose height are shorter than 97% of other children of the same age and gender [1]. Stunting is often misunderstood as simply being short when in fact, poor nutrition or a medical condition is impairing a child’s growth and development.

How are children growing in Malaysia?

Stunting affects large numbers of under‐fives in Malaysia. With a stunting rate of 21.8 per cent, one in five children under five in Malaysia are stunted [2]. This is three times higher than the 7% prevalence among upper middle-income countries [3].

Over the past decade, stunted growth has become more common among children in Malaysia. Malaysia’s national prevalence of stunting in children under five years was 21.8 per cent in 2019, rising from 17.2 per cent in 2006 [4].

Stunting is not an exclusively B40 thing either. It happens across income levels, education levels, occupations, and ethnicities. Even in families with a monthly household income of above RM5,000, stunting prevalence is about 17 per cent.

Should you be worried if your child is short?

Many parents are not aware that child height is related to nutrition, health, or overall growth. They may attribute their child’s short stature to hereditary or genetic factors or assume that their child will ultimately catch up with his or her peers.

Stunted growth is largely irreversible [5], and it is not just about being short. It can be a red flag for an underlying medical condition that can have a major impact on the overall health and wellness of a child’s life. In fact, one in five short statured children have a medical reason for being short [6].

Children who are not growing at a normal rate for their age may be afflicted with growth hormone deficiency (GHD). GHD is not a common cause for very short kids. That said, it is typically suspected when a child exhibits a slower growth rate than normal. In fact, kids with normal height but poor growth may have GHD.

What is GHD?

GHD occurs when the pituitary gland does not produce enough growth hormones to stimulate height growth and allow a child to grow at a normal pace. Therefore, GHD itself typically manifests as growth failure. GHD is part of a genetic condition in some children, but in most cases, the cause of the deficiency is unknown (Idiopathic GHD) [7].

Children who have this condition are significantly shorter and grow at a slower rate than other children of the same age and gender. They also look very young for their age.

Although a child’s short height is apparent early on, the signs of GHD can be easily overlooked. This is because these children appear to have normal body proportions and look like just any other child, albeit with a small stature [8].  

Consequently, children with GHD are often discovered late, usually at the age of puberty, when children exhibit a delay in pubertal growth spurt [9]. At this stage, the child would have already lost the opportunity to gain benefit from early treatment.

This is a serious concern as the health consequences of untreated GHD also extends beyond height. Growth hormone contributes to other important bodily functions such as maintaining muscle and bone mass, decreasing fat tissues, influencing blood lipid levels such as cholesterol and triglycerides, and regulate cardiac function [10] [11].

Therefore, children with untreated GHD not only loses their opportunity to attain their potential adult height determined by their genetics [12], but they are also at risk of health issues like decreased bone mineral density, high cholesterol, high blood pressure, obesity, and heart diseases in later life [12] [13].

Early recognition of GHD is important to allow affected children gain the maximum benefit from growth hormone treatments. Growth hormone treatments help children with GHD attain a normal adult height, restore metabolism, enhance body development, and reduce the risk of heart disease.  

What treatments are available?

The most common treatment for GHD is daily injections of synthetic growth hormones. It is received through an injection pen that makes a shallow injection into the fatty tissue just beneath the surface of the skin. The treatment is carried out over several years until the child achieves a normal adult height or reaches their maximum height potential, usually when puberty has completed.

The injection dosage varies with every child depending on different factors including the severity of their deficiency as well as body weight. For example, a child would require higher doses of growth hormones as they grow because their body weight is increasing.

Children undergoing growth hormone therapy would need to visit their doctor regularly to monitor their progression of growth. Blood tests will be carried out to determine if extra growth hormone is needed and if treatments should be increased, decreased, or stopped. Cholesterol levels, blood sugar levels, and bone density will also be checked to see if they are healthy.

How can parents detect GHD?

Given that growth is connected in many ways to health, a child’ height is often a sign of a child’s overall health.

In Malaysia, once the children have completed their immunisation by the age of two, parents will only bring them to see the doctor when they fall ill. There is no proper follow-up for the child’s growth beyond this age.

Therefore, parents are key players in their child’s healthy growth by being aware and involved in their child’s growth trajectory. Through regular height measurement, parents can identify the signs of abnormal growth and get their child examined by a paediatrician in time.

Monitoring child height is simple with new innovative tools such as smartphone applications that can help parents measure and track their child’s physical growth milestones conveniently. Parents can easily get started on tracking their child’s height by using these tools to guide them on their child’s growth pattern and feel more confident about what they observe.

These applications record a child’s height on a growth chart and compare it with the WHO’s standard for healthy child growth. Any child whose height falls below the standard height for their age and gender (shorter than other children their age) or falls away from their previous growth curve (growth rate has slowed) may have stunted growth and should be evaluated by a doctor.

Short stature in children should not be disregarded. The earlier GHD is treated in children, the better chance they have in reaching their height potential and prevent the health issues that comes with the condition.


References

[1] Craig Barstow and Caitlyn Rerucha. 2015. Evaluation of short and tall stature in children. American Family Physician 92(1): 43-50.

[2] Institute for Public Health. 2020. The National Health and Morbidity Survey 2019: Key Findings. Institute for Public Health, Ministry of Health, Malaysia.

[3] Derek Kok. 2019. Stunting in Malaysia: Cost, Causes and Courses for Action. Jeffrey Cheah Institute of Southeast Asia. https://jci.edu.my/wp-content/uploads/2019/10/JCI-JSC-WP-2019-01-Stunting-in-Malaysia.pdf.

[4] Global Nutrition Report. 2020. 2020 Global nutrition report: Action on equity to end malnutrition. Bristol, UK: Development Initiatives.

[5] Black RE, Victora CG, Walker SP, et al. 2013. Maternal and child undernutrition and overweight in low-income and middle-Income countries. Lancet 382(9890): 427-451.

[6] Tim Cheetham and Justin H Davies. 2014.  Investigation and management of short stature. Archives of Disease in Childhood 99: 767-771.

[7] Thomas et al. 2004. Prevalence and demographic features of childhood growth hormone deficiency in Belgium during the period 1986-2001. European Journal of Endocrinology 151(1): 67-72. doi: 10.1530/eje.0.1510067.

[8] Human Growth Foundation. 2020. Pediatric Growth Hormone Deficiency. Human Growth Foundation. https://www.hgfound.org/pediatric-growth-hormone-deficiency.

[9]  Pediatric Endocrinology Associates. 2020. Growth hormone deficiency. Pediatric Endocrinology Associates. Available at: https://pediatricendocrinologynj.com/growth-hormone-deficiency/.

[10] Judith Ross et al. 2010. Growth Hormone: Health Considerations Beyond Height Gain. Official Journal of the American Academy of Pediatrics 125 (4): e906-e918. DOI: https://doi.org/10.1542/peds.2009-1783.

[11] Shalet, S. M., Toogood, A., Rahim, A., & Brennan, B. M. 1998. The diagnosis of growth hormone deficiency in children and adults. Endocrine reviews 19(2): 203–223. https://doi.org/10.1210/edrv.19.2.0329.

[12] Bradley S. Miller. n.d. Growth Hormone Deficiency. The Magic Foundation. Available at: https://www.magicfoundation.org/Growth-Disorders/Growth-Hormone-Deficiency-in-Children/.

[13] Boston Children’s Hospital. 2020. Growth Hormone Deficiency Symptoms & Causes. Boston Children’s Hospital. https://www.childrenshospital.org/conditions-and-treatments/conditions/g/growth-hormone-deficiency/symptoms-and-causes.

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