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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 growth failure?

It isn’t always easy to find accurate information on your own: that’s why it’s important to tell the doctor about your concerns and find out if there’s a medical issue.

Your journey (and your child’s) might begin like this:

• You recognize that something may be wrong with your child’s growth, 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 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 than his or her classmates?
• 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

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 variety of medical conditions, some serious, 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.

Although children who are very short or very tall may be healthy and normal, some children have diseases or conditions that affect their growth. A child’s growth rate can be a more important clue to the presence of a growth problem than his or her size.

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 to a pediatric endocrinologist at this point: doctors may not be as quick to recognize growth problems in girls.

If there’s a medical issue, take steps now

If your doctor suspects there’s a medical issue, he or she may refer your child to a specialist for testing. Testing can take time—but it’s important.

• Your child may need to see a pediatric endocrinologist or other specialist for a clinical assessment—an evaluation based on a physical exam, lab work, and the patient’s medical history
• Tests are necessary to see if there is a problem
• These tests can take time—and patience—to get through
• At this stage, tests are likely to include:
  • Bone age X-rays
  • Stimulation or “stim” testing
  • Lab tests
  • An MRI—a test that can create detailed pictures of the inside of the body

Your doctor may review the test results and discuss treatment options with you and your child. Use this time to get your questions answered. Ask your doctor or nurse about:

• What to expect
• How long it may take to get test results
• What it means if your child needs GH therapy
• If there’s an illness
• Where to find reliable information about GH therapy
• What the test results mean
• What it means to have PGHD

Finding out what’s going on with your child’s growth may take patience at times, but it’s important. Some other issues you may want to talk about:

• Your child didn’t like the test—and 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. It’s even a little scary!
• How, exactly, is the injection given, anyway?
• How do I know I’m doing it right?

IMPORTANT SAFETY INFORMATION

Nutropin and your safety:
Please read this important safety information carefully. Then, if you have any questions, talk with your doctor.

Nutropin is NOT for:

• Children and teenagers whose bones have finished growing
• Patients who have certain types of eye disease caused by diabetes
• Patients who have active cancer or any brain tumors
• Patients who are critically ill after open heart surgery or abdominal (stomach) surgery, are severely hurt, or have severe breathing problems
• Children and teenagers who have Prader-Willi syndrome and are very overweight or have trouble breathing
• Patients with a known sensitivity to benzyl alcohol when using Nutropin reconstituted with Bacteriostatic Water for Injection, USP (benzyl alcohol preserved). For use in newborns, see WARNINGS in full Prescribing Information

If any of these apply, talk to your doctor before you start taking Nutropin.

If you are about to start taking Nutropin, or are already taking it, be sure to tell the doctor who prescribed it:

• About ALL of the medications you are taking, including supplements
• If you have or develop a brain tumor
• If you are given any new medication, especially glucocorticoid steroids like hydrocortisone or prednisone
• If you are pregnant or if you become pregnant
• About ANY other condition or illness you have or develop

What are the possible side effects of Nutropin?
You may experience discomfort, soreness, or redness where Nutropin is injected.

Contact your doctor immediately if you experience:

• Ongoing injection site discomfort
• Curvature of the spine (scoliosis)
• Joint pain
• Puffy hands and/or feet (caused by fluid retention)
• Changes in vision, a bad headache, or nausea with or without vomiting
• Hip or knee pain
• A need to limp when you walk
• Pain in wrist (carpal tunnel)
• Allergic reaction

Be sure to inject Nutropin at a different recommended place on your body each time. Your doctor or nurse should supervise the first injection and provide training and instruction.

Your doctor is your primary source of information about your treatment.

Please see the full Prescribing Information for Nutropin and Nutropin AQ, available from your pharmacy and at www.nutropin.com, for more about Nutropin and safety.

Questions? Call the Nurse Hotline at 1-866-NUTROPIN (1-866-688-7674).

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