For many families, the first sign of what may be growth failure comes when classmates seem to be growing faster than their child. But is it really growth failure?
It’s important to tell your doctor about your concerns and find out if there’s a medical issue. Your child’s healthcare professional can best assess the possibility of kidney disease, usually beginning with a detailed health history and physical exam.
A standard urinalysis and lab tests that measure blood electrolytes can help confirm a diagnosis of kidney disease. If these signs do not point to kidney disease, chances are good that kidney disease is not the cause of any growth problems.
If kidney disease is confirmed, your journey might begin like this:
- Your child has chronic kidney disease (CKD) and is not growing well
- You recognize that something may be wrong, and ask your doctor about it
- Your doctor takes a closer look
- Your doctor refers you to a specialist for testing
- If the doctor decides it’s needed, your child gets a prescription for growth hormone (GH) therapy
How you can take action:
- Start with this checklist
If you’re concerned about a child’s or a teenager’s growth, use these questions and your answers as a guide. Ask yourself these questions*:
- Is my child the shortest in his or her class?
- Is my child still wearing smaller clothing sizes?
- Is my child growing less than 2 inches a year?
- Is my child complaining about his or her size?
- Has my 13-year-old girl or 15-year-old boy failed to show signs of sexual development?
While a “Yes” answer doesn’t necessarily mean there’s a problem, it may mean it’s time to have a discussion with your child’s healthcare professional. Print the checklist out and bring it along on your doctor visit. You can also use the Doctor Discussion Guide.
*This list is based in part on Human Growth Foundation (HGF) publications. For more information, contact: Human Growth Foundation, 997 Glen Cove Avenue, Glen Head, New York 11545, or call toll-free: (800) 451-6434.
- Follow up with your doctor
Although most children who are very short or very tall are healthy and normal, some children have diseases or conditions that affect their growth. A child’s growth rate is a more important clue to the presence of a growth problem than is his or her size.
When you bring up your child’s growth, your doctor may use a pediatric growth chart—a grid that lets you plot a child’s height according to age—to see how tall your child is compared with kids the same age and sex.
If there is a delay in growth, the big question is: what’s causing it? Because poor growth may be a symptom of a medical condition, any child whose height is below the 5th percentile line on the pediatric growth chart, or who moves away from a previously normal growth curve, should be checked over time by a healthcare professional.
A change in the growth rate may provide the first hint of an underlying problem. When growth slows to less than 2 inches (5 cm) per year, it could be a sign of pediatric growth hormone deficiency or a chronic illness. At this point, it may be time to see a pediatric endocrinologist—an expert in hormones, glands, and how our bodies grow.
Note: If your child is a girl, you may want to ask for a referral at this point: doctors may not be as quick to recognize growth problems in girls.
- If there’s a medical issue, take steps now
Your child’s healthcare team may conduct tests to check for certain blood chemical levels. If dietary and nutritional changes alone do not improve your child’s growth, the healthcare team may recommend GH therapy.
Your doctor may discuss treatment options with you and your child. You can also use the time to get your questions answered. Ask your doctor or nurse about:
- What to expect
- If my child needs growth hormone (GH), what does that mean?
- Where to find reliable information about GH
- How GH therapy may help with CKD
Finding out what’s going on with your child’s growth may take a little patience at times, but it’s important. Some other issues you may want to ask about:
- Your child doesn’t look forward to the therapy
- You don’t know what to expect—should you get your hopes up?
- You don’t think giving your child an injection every day for years sounds very appealing.
- How, exactly, is the injection given, anyway? How does it work? How do I know I’m doing it right?
WHO IS NUTROPIN THERAPY FOR?
Nutropin AQ [somatropin (rDNA origin) injection] is human growth hormone that is available by prescription only in a disposable pen called NuSpin.
Doctors prescribe Nutropin therapy for children and teenagers who are short or growing slowly because they:
- Do not make enough growth hormone on their own
- Have idiopathic short stature, which means they are shorter than 98.8% of other children of the same age and sex; are growing at a rate not likely to allow them to reach normal adult height; and no other cause of short stature can be found
- Have Turner syndrome
- Have chronic kidney disease (CKD) up to the time of kidney transplant
Doctors prescribe Nutropin therapy for adults who have growth hormone deficiency that began either in:
- Adulthood as a result of pituitary disease, diseases of the hypothalamus, surgery, radiation therapy, or trauma; or
- Childhood. Patients treated for growth hormone deficiency in childhood, whose bones have stopped growing, should be reevaluated to see if they need to continue with growth hormone therapy
Your doctor will test to see if growth hormone is right for you.
IMPORTANT SAFETY INFORMATION
Nutropin therapy and your safety:
Please read this important safety information carefully. Then, if you have any questions, talk with your doctor.
NUTROPIN THERAPY IS NOT FOR:
- Patients having serious complications after undergoing open heart surgery, abdominal surgery, serious injuries involving many body systems, or life-threatening breathing problems. Deaths have been reported in such cases
- Children who have Prader-Willi syndrome (PWS) and are very overweight or have a history of severe breathing problems. Deaths have been reported in children with PWS who are very overweight, have a history of blocked upper airways, sleep apnea (pauses in breathing during sleeping), or other severe breathing problems
- Patients who have active cancer. Because growth hormone deficiency can be an early sign of some tumors in the brain or pituitary gland, the presence of these types of tumors should be ruled out by your doctor before you start Nutropin therapy
- Adults or children with certain types of eye disease caused by diabetes
- Children and teenagers whose bones have finished growing
- Patients who are allergic to somatropin, the active ingredient in Nutropin therapy. Reactions at the injection site are the most common allergic reactions
What should you tell your doctor before starting Nutropin therapy?
- If you take cyclosporine, hormone replacement therapy, insulin or other diabetes medications, drugs containing steroids, or drugs for seizures. These medications may need to be adjusted during Nutropin therapy
- If you have preexisting tumors or growth hormone deficiency caused by abnormal tissue in the brain. If so, you should be watched closely for the worsening or return of this condition. If you had cancer as a child, an increased risk of a new tumor, particularly certain brain tumors, has been reported in patients taking Nutropin therapy
- If you have diabetes, risk factors for diabetes, or impaired glucose tolerance. If so, your doctor should monitor your blood sugar closely during Nutropin therapy. New cases of type 2 diabetes have been reported in patients taking Nutropin therapy
- If you have hypopituitarism (an inability of the pituitary gland to produce sufficient hormones) and are on standard hormone replacement therapy. In that case, your doctor should monitor your hormone replacement therapy closely while you are taking Nutropin therapy
- If you are pregnant, nursing, or plan to become pregnant. It is not known whether Nutropin is excreted in human milk. Nutropin therapy should be used during pregnancy only when clearly needed
While taking Nutropin, contact your doctor immediately if you experience:
- Changes in vision, a bad headache, or nausea with or without vomiting. This may be a sign of increased pressure in the brain
A limp or have hip or knee pain
- A fracture in the ball of the hip joint can occur in children who have endocrine problems and in children who have rapid growth
- Children with growth failure due to CKD should be examined periodically for evidence of loss of bone minerals. Hip X-rays should be taken before starting Nutropin therapy in these children
- Progression of scoliosis (curvature of the spine) that can occur in children who have rapid growth. Nutropin therapy has not been shown to increase the occurrence of this condition
- Any allergic reaction you experience to the injection of Nutropin therapy
- Abdominal pain. Cases of pancreatitis (inflammation of the pancreas) have been reported rarely in children and adults receiving Nutropin therapy
Other important information about Nutropin:
- Adults may retain water during Nutropin therapy. This may be brief but may increase with higher doses of Nutropin therapy
- Patients should have their thyroid function tested periodically during Nutropin therapy. Thyroid hormone treatment may need to be started or adjusted
- Patients should be sure to inject Nutropin at a different recommended place on their body each time to avoid tissue breakdown. A doctor or nurse should provide injection training and supervise the first injection
- The use of Nutropin therapy has not been studied in patients over 65 years of age. Elderly patients may be more sensitive to Nutropin therapy and may experience more side effects
- Patients with Turner syndrome should be monitored closely by a doctor for ear infections and cardiovascular problems during Nutropin therapy
- Nutropin therapy may affect the body's ability to process two hormones, cortisol and cortisone, which can lead to a condition called hypoadrenalism (underactivity of the adrenal gland). In that case, glucocorticoid replacement therapy may need to be prescribed
What are common possible side effects of Nutropin therapy?
Common side effects reported in adults and children taking Nutropin therapy include injection site reactions. Additional common side effects in adults include swelling, joint pain, and carpal tunnel syndrome.
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.
How should you store Nutropin?
Nutropin must be kept refrigerated (36° to 46°F [2° to 8°C]). Do not freeze. Cartridges and NuSpin pens must be used within 28 days of initial use. Throw away any unused Nutropin after 28 days of initial use. Before giving an injection, check the manufacturer's expiration date on the cartridge or pen. Do not use if it has expired. Do not inject medication if the solution is cloudy.
Your doctor is your primary source of information about your therapy.
Questions? Call the Nurse Hotline at 1-866-NUTROPIN (1-866-688-7674).
Please see additional Important Safety Information below.