How do healthcare providers evaluate growth problems?
The first thing parents should do if they're worried about their child's growth is take the child to a pediatrician or another healthcare provider. First, the healthcare provider will decide whether the child's size or growth curve is a cause for concern. If it is, a series of possible causes of short stature and growth failure must be considered and your child may be referred to an endocrine specialist.
The healthcare provider may need to measure your child's height over a period of 6 to 12 months to evaluate the child's current growth rate. These measurements should be plotted on a pediatric growth chart along with as many earlier measurements as possible. Your child's healthcare provider or school often will have records of yearly height and weight measurements.
Working with your healthcare provider
The healthcare provider may ask questions about your child's current health, diet, appetite, and habits, and past illnesses and injuries. The healthcare provider will also ask for information about the mother's pregnancy, labor, and delivery, because these may provide a clue to the cause of the child's short stature. Questions about your child's progress in school, general mood, and home life are important in getting to know your child as a person, but also may shed light on your child's growth problem.The healthcare provider will ask about the health of other family members, and will want to know the heights of parents, grandparents, siblings, and other close relatives. Be sure to tell the healthcare provider about any diseases or problems that run in the family, as well as about any history of early or late puberty (growth spurt and sexual development) in family members.
X-Rays and scans
X-rays or scans may be done to check on the condition of the pituitary gland (a small gland attached to the base of the brain). Blood tests can inform the healthcare provider about the condition of the kidneys, bones, and thyroid gland. The amount of insulin-like growth factor I (IGF-I; somatomedin) in the blood may also be checked. This is a substance that provides an indirect measure of the amount of growth hormone in the body.An X-ray of the child's hand and wrist may be taken to check the child's bone age. In some short children, the maturity of the bones lags behind the child's actual age, and the child is said to have a delayed bone age. The bone age may be delayed for a variety of reasons, so it is not very helpful in finding the cause of short stature. It is, however, useful in determining a short child's growth potential, and this is one instance in which delayed maturity is a good sign. A 9-year-old boy who has a bone age of 7 years, for example, has about 2 years more growth potential, or room to grow, than the average 9-year-old. This is because the development of his bones is more like a 7-year-old boy's than like a 9-year-old's. However, this child's delayed bone age can "catch up" to his chronological age in less than 2 calendar years, especially after he enters puberty. Some of the changes that occur with the development of bones throughout childhood are shown in X-rays.
Predicting Adult Height
By referring to a special chart, the healthcare provider can predict an approximate adult height based on the child's current bone age and height. It's important to remember that these predictions are only educated guesses, and that the child's adult height will be the result of many factors, including the parents' heights, the child's general health and state of nutrition, the age at which puberty begins, and the length and vigor of the pubertal growth spurt. In general, height predictions are more reliable as the child becomes older.
Tests for growth hormone secretion
Stimulation testing for growth hormone secretion may be performed after other causes of growth failure have been considered and ruled out. Growth hormone is secreted by the pituitary gland in quick bursts and does not last long in the bloodstream, so checking a single blood sample is not likely to be helpful. The amount of growth hormone in the bloodstream is measured by taking one or more small blood samples over a period of time. This may be done in the healthcare provider's office or during a brief hospital stay. The results of these tests will indicate whether the child's growth problem is caused by a deficiency of growth hormone.The amount of testing that a child needs depends on what the healthcare provider finds at each step of the evaluation. A short child who is healthy and growing at a normal rate may be observed periodically throughout childhood, while a child whose growth has stopped will need more involved testing. The evaluation process may make more sense if we take a closer look at some of the variations in the normal growth pattern and some of the causes of abnormal growth.
