Growth disorders

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at September 1, 2016
StartDiseasesGrowth disorders

A growth disorder is defined as a condition that prevents children from developing to a normal height, weight, or physical maturity. Most disorders result in a lack of growth, but there are several conditions that can cause children to grow more than is normal or healthy.

Contents

Definition & Facts

Growth disorders can cause children to be much smaller than their peers or abnormally large. The abnormal growth patterns may be the result of problems with the pituitary gland or another endocrine disease. Examples of growth disorders include Turner syndrome (a genetic disorder), hypothyroidism, and failure to thrive.

The general prognosis for children with growth disorders depends on the underlying cause. In some cases, treatments are highly effective and children can participate in normal lives. However, there are conditions that can be difficult to treat, and the prognosis will depend on the ability to treat associated symptoms and complications.

Symptoms & Complaints

Some growth problems are identified in utero or right at birth (newborn screening), and others will take time to manifest. One common symptom is when children are growing less than two inches a year after their third birthday.

With certain forms of dwarfism, people may have limbs that are not proportional to their torsos. Certain types of growth disorders involve a loss of energy, constipation, dry hair and skin, and difficulty regulating body temperature. Those with low growth hormone levels may have very young looking faces.

The symptoms can also be more serious if the delays are related to gastrointestinal disease. In these cases, children who are lagging behind their peers in height may also have chronic problems with bloody stools, constipation or diarrhea, nausea or vomiting.

It’s also possible for children to grow too much, as is the case with gigantism. This condition results in excessive growth, and patients will wind up being very tall with large skulls, hands and feet. There several health problems associated with this condition, such as heart disease, vision problems, and delayed puberty.

Causes

Short parents tend to have short children, and very tall parents can expect to have tall children. Constitutional growth delay involves children entering puberty later, but continuing to grow to a later age. Ultimately, they will catch up with their peers. This is also not a disorder and it generally considered normal development for that individual.

Growth disorders are typically the result of some type of illness or disorder. Illnesses that affect the entire body, including constant malnutrition, diabetes, severe stress, and chronic kidney disease, lung disease, and heart disease can lead to growth problems.

Patients should also be aware of growth problems that may be caused by taking certain drugs during pregnancy.

There are a variety of endocrine diseases that result in abnormal growth patterns. Low levels of GH (growth hormone) or thyroxine due to hypothyroidism can also lead to problems with delayed growth.

Congenital disorders are present at birth, and they can cause a range of complications in addition to the tall or short stature. Examples include Marshall-Smith Syndrome, chromosome abnormalities, Turner syndrome, and dwarfism.

Diagnosis & Tests

Children who are in the 97th percentile with other kids are considered normal. If a child falls outside of this range, then the doctors may request more testing to determine if there is a problem. In some cases, the very large or small child is still healthy and normal, but the medical community will still conduct some testing to be sure.

Growth disorders may be diagnosed over time through careful tracking of height and by reviewing the child's family history. In a child who appears normal otherwise, doctors may carefully monitor his or her health and growth over a period of time. X-ray]s are commonly used to take a closer look at the bones and see if they appear normal. Finally, doctors may look at the pituitary gland functions to determine if it’s working properly.

With most growth disorders, there are blood tests that can provide doctors with accurate information. This is the case with hormonal imbalances and a range of diseases, including stomach, bowel, kidney, and bone disorders. The majority of growth hormone production occur while children are sleeping, so the doctor may have a child spend the night in the hospital in order to get an accurate reading.

Treatment & Therapy

In the case of delayed growth, there are different hormone treatments that can be used to encourage growth and normalize patterns. These treatments typically continue for several years in order to help the child achieve a more normal height.

Acromegaly is a condition where the body produces too much of the growth hormone, and one treatment option involves surgery. The condition is commonly caused by a small, benign tumor in the pituitary gland, but removing it allows for proper regulation or hormones and growth. If necessary, medication may be used to block the release of growth hormone and effectively stall the rate of growth.

When the delay is a result of malnutrition or disease, then the first line of treatment will involve addressing that issue. In general, as the underlying illness is effectively treated, the growth patterns will normalize and children will resume typical growth levels. However, hormonal treatments may be required to help regulate the body again.

In some cases, the doctors may determine that certain risks associated with treatment are greater than the potential benefits. When this occurs, they may discuss other treatment with the patient or suggest that no steps are taken to address the growth.

Prevention & Prophylaxis

Growth problems may be preventable in certain cases linked to diet by following a healthy lifestyle when pregnant and ensuring that children are provided with all the food, vitamins, and minerals they require.

If there is a family history of growth problems, then families should discuss their concerns with the doctors ahead of time. With most of the diseases and conditions, it cannot be prevented, but treatments may be available to overcome the challenges and allow for more normal growth.