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beckyjo

When to worry about child's height

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Both DH and I come from short families.  Our mothers are 4'11" (pre-osteoporosis height) and 5'1". Our fathers were 6'0" and 5'11" (they were literally the only tall people in the families). Only sibling is male 5'8". 

 

DH is 5'5" and I am 5'3". We have 3 daughters. 

 

Oldest child is 15 and has topped out at 5'1" (she has scoliosis, so I know that this is her adult height - she did lose about 1/2 - 1 inch of height due to the spinal curve). Middle is 1 month shy of 12 and is right at 5'0"; I expect her to be about 5'2"-5'4".

 

Youngest, however, just had her 10th birthday in March - she is 4'0". That puts her well below the 1st percentile. She has been classified as short stature since before her second birthday. She just never seems to catch up. She's starting to get tired of people assuming she's a 6 year old. We always assumed she would end up about 4'10" - that is starting to feel like it might not be possible. I don't think she is near puberty yet, but her sisters (and I) started menstruation before age 12.

 

Health wise: she's pretty healthy with the exception some mild kidney problems: surgery as an infant (extra ureter), some mild hydronephrosis (backed up urine in both kidneys), and a cyst being monitored on one kidney. 

 

What are the pros/cons of growth hormone therapy? Are there any other options to help a child grow? 

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Has she been tested as GH deficient?  Until you run a GH stimulation test, you really can't know what's going on.  If she is deficient, it is a good idea to start her ASAP, but if she is not deficient, she shouldn't take it.  There are side-effects to not producing enough naturally, there are side effects to taking it, and there are certainly side effects to taking it when you are not actually in need.  

 

Has she has a bone age scan?

Has she been tested for celiac?  

 

I have two children who are monitored by an endocrinologist for growth issues.  So far, only one has been through a GH stim test, and the results came back normal.  Her bone age is a bit young, but it is hard to interpret that test in young children because the standard deviation is relatively large.  

 

Basically, you will need to seek out a pediatric endocrinologist if you don't already have one and get tests run.  It could be nothing at all, or she could need treatment.

 

 

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have you checked her growth plates or growth hormone levels?

 

I have an acquaintance who does growth hormones for one of her adopted sons.  his bio dad was really tiny. she did have to push for them though.  she also adopted his maternal cousin (they were born close together - the state treated it like twins), and he had much more normal height.

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Has she been tested as GH deficient?  Until you run a GH stimulation test, you really can't know what's going on.  If she is deficient, it is a good idea to start her ASAP, but if she is not deficient, she shouldn't take it.  There are side-effects to not producing enough naturally, there are side effects to taking it, and there are certainly side effects to taking it when you are not actually in need.  

 

Has she has a bone age scan?

Has she been tested for celiac?  

 

I have two children who are monitored by an endocrinologist for growth issues.  So far, only one has been through a GH stim test, and the results came back normal.  Her bone age is a bit young, but it is hard to interpret that test in young children because the standard deviation is relatively large.  

 

Basically, you will need to seek out a pediatric endocrinologist if you don't already have one and get tests run.  It could be nothing at all, or she could need treatment.

 

 

We have tested for celiac (negative) although my MIL has it. 

 

She has had nothing else done. Her doctor retired just 3 months ago; I guess it's time to find a new one and ask about an endocrinologist.

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I have one child (DS8) with growth delays -- but he has other medical issues. At age 8, he is about the size of an average 4 year old.

 

I can tell you that it's been my experience that they will want to rule out any other possible issues, and there is testing your DD would have to undergo, before they would even begin to suggest growth hormones. At least around here. My son isn't considered eligible (or, rather, not a good candidate) for other reasons, but it was discussed. If you move forward with the concerns, it is likely they will want blood work ups, bone age scans, possibly other scans, and they may want her to see other specialists. GH is considered pretty serious stuff -- at least my son's endo seems to treat it that way, lol.

 

DS8 continues to see an endocrinologist. I would say that if you're concerned, ask your pediatrician for the name of a good ped's endocrinologist. 

 

Genetic short stature really IS a thing, though, so if that's the only concern with her health, I wouldn't be too worried if I were you. I'm 5'1", DH is 5'3" and we have a history of both very short women and very short men... so if DS had just presented as very small, with no other physical differences or other medical issues, I don't think we would have been concerned, given the family history.

Edited by AimeeM
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In additon to growth hormones, having thyroid and THC checked may be a good idea. I was diagnosed as hypothyroid at age 11 and once I started levothyroxine shot up something like 6 inches in less than a year.

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We have tested for celiac (negative) although my MIL has it. 

 

She has had nothing else done. Her doctor retired just 3 months ago; I guess it's time to find a new one and ask about an endocrinologist.

 

 

Definitely.  My understanding is that growth hormone really needs to get started well before puberty hits for best results, IF she needs it.

 

Where I live, GH is considered a very closely controlled substance.  They WILL NOT give it without a GH stim test showing a lack of GH.   If you have idiopathic short stature, than... you just end up short.  Although this is tough for people of shorter stature, moving everyone who is well below average to GH injections simply pushes up the averages and exacerbates the problem.  

 

I'm sure you are aware, but GH is administered by daily injection.  I would not go that route for my kids unless it were medically necessary.  And I would not withhold it if it were necessary.  

 

My little guy is will probably have his GH stim test scheduled in about 6 moths or so, but I'm guessing he'll just be a weird anomaly like his sister.  

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Kidney problems does cause some growth retardation. What does her pediatrician say about her height? I have no idea what tests to run but I had done volunteer work with children on kidney dialysis and on growth hormone therapy to want to have tests run for my child.

 

ETA:

The doctors were recommending growth hormone therapy to start at 10 to 12 years old and that was 20 years ago at a university hospital.

Edited by Arcadia

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Kidney problems does cause some growth retardation. What does her pediatrician say about her height? I have no idea what tests to run but I had done volunteer work with children on kidney dialysis and on growth hormone therapy to want to have tests run for my child.

 

ETA:

The doctors were recommending growth hormone therapy to start at 10 to 12 years old and that was 20 years ago at a university hospital.

 

Her doctor (gp) has always kept a close eye on her height - we did 3 month growth checks until age 3. She has never, ever grown well. At first she was on some heavy duty meds until age 2 for kidney problems. He expected her to "shoot up" after she went off of them. She didn't. 

 

Part of it is we are a very short family, part of it is she is monitored by a urologist and a nephrologist, so he's been willing to let it go as long as there was some kind of growth curve. She has not had any growth for a couple of her annual checkups, but then the next time she grew just enough to put her back on her growth curve. She's always just barely hit his line that he was looking for before he sent her to a specialist. 

 

I'm getting afraid that not pursuing it at this point is kind of closing the door - I know things change after puberty starts. 

Edited by beckyjo

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I don't have direct experience in this. But a friend has a child who was quite short. After thousands and thousands of dollars worth of testing, someone thought to look at ferritin levels. They were low. Iron supplements (not sure exactly what kind), no other meds, were given, and child grew several inches within a year.

 

Just posting to say that ferritin might be one of many tests you might consider.

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Her doctor (gp) has always kept a close eye on her height - we did 3 month growth checks until age 3. She has never, ever grown well. At first she was on some heavy duty meds until age 2 for kidney problems. He expected her to "shoot up" after she went off of them. She didn't. 

 

Part of it is we are a very short family, part of it is she is monitored by a urologist and a nephrologist, so he's been willing to let it go as long as there was some kind of growth curve. She has not had any growth for a couple of her annual checkups, but then the next time she grew just enough to put her back on her growth curve. She's always just barely hit his line that he was looking for before he sent her to a specialist. 

 

I'm getting afraid that not pursuing it at this point is kind of closing the door - I know things change after puberty starts. 

 

I do think you should pursue it.  Having said that, if she is on a growth curve, even if it's the 1-5% curve, she'll probably be ok without treatment.  

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I would pursue it, because getting information doesn't mean you have to act on it, but waiting too long means you can't act on it. 

 

My oldest dd is 4'9" and her sister is an inch taller. That's short enough to be a bother in everyday life - I mean, I'm 5', and footstools and reachers are part of my everyday life, lol. At 10, she was 4" 4". She started her period at 11. 

 

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I would be worried. We are trying to find answers for my youngest. The pediatrician has been closely tracking her growth for a while. She has had a bone age X-ray. Her growth velocity is reduced. We have other indications now to warrant an appointment with a pediatric endocrinologist in just over a week.

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We're in a similar situation with my oldest DD, who just turned 9. She's always been under the 5th percentile in height, but two years ago she deviated from her growth curve for the first time. This prompted her pediatrician to refer her to a pediatric endocrinologist.

 

We've been through all of the testing: 

 

First, the blood tests: The only "red flag" was a one-off test showing high TSH. They retested it (and did a full thyroid panel) and she was back to normal. The endo said it's not unusual for those levels to fluctuate in kids. 

 

Then, the bone scan: The two bone scans she had showed her growth behind, but less than a year. For example her last scan showed her bone age at 7years 10months but her actual age was 8 years 6 months.

 

Lastly: She had the GH test which showed that she was not growth hormone deficient. 

 

So, after all of that, she was diagnosed as idiopathic short stature (healthy, but short). For now, we've opted out of doing GH shots, although the endo offered to start them. The cons (YEARS of daily injections, no guarantee the shots will make her taller, possible side effects on a healthy child) seemed to outweigh the pros (possibly gain inches in height).

 

The decision for us was hard though. She's so much smaller than her peers and her little sister (who just turned 7) is now the same height. I just did a quick measurement on them, and they're both at almost 47 inches. We’ve always kept an open dialogue with her about her being short and how that’s ok and that she can still be just as successful in life as someone who is taller. She’s okay with it, for now, but I’m concerned about that changing as she gets older. 

 

I would definitely suggest getting all of the testing done, just to make sure there's not some underlying cause. At this point, I haven’t found any other options for promoting growth, but I’m always looking. For now, the pediatrician and the endocrinologist will continue to monitor her growth. At the last endo appointment, she got back on her curve, which was good. 

 

I’m sorry I’m not much help, but it’s comforting to hear that others are going through a similar journey. Good luck to you.  :grouphug:

Edited by Vintage81
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Some people are just going to be short.

 

However, if you're going to do something about this kid's growth, now is the time to do it - she's probably about to hit puberty in a big way. Speak to your doctor now. I'd even make a special trip for this if both you and she think it's important.

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It's so interesting to me the way things have changed over the last 30-40 years. When I was 10, most of my friends were around that height. I specifically remember being at the end of 4th grade (so 10.5) and being 48 inches tall/48 pounds. I thought it was neat to have all of those 4s, ;) Most of my friends were maybe just a tiny bit taller--nothing really noticeable.

 

I'm now 5'3.5", so definitely not tall, but fairly average. I grew 2 inches in college, so 5'1" at my HS graduation. My older DD has been my size, age for age, all of her life. At every single Dr. appt, I've heard about how small she is. At least I've been able to say that she's exactly the size I was at that age, which usually ends the "concern."

 

I'm not saying that you don't have a reason to be concerned if you feel like something may be wrong, but that was a pretty average size for a 10-year-old girl not that long ago.

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The cons (YEARS of daily injections, no guarantee the shots will make her taller, possible side effects on a healthy child) seemed to outweigh the pros (possibly gain inches in height).

 

 

I do think the inches in height matter a lot more if you are at the extreme end of short.

 

My oldest is 4' 9" and youngest is 4' 10" and both are done growing. That's definitely in the arena of being a bit troublesome in everyday life, and hearing comments about it. And that one inch does seem to make a difference in people noticing. 

 

If I had another child and it was possible they would be even shorter, I would research and strongly consider treatments. Four foot ten is a big difference from four foot seven, y'know? Whereas five foot one even is less of a difference from four ten. 

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I agonized over eldest ds, had hormone test, bone x-rays, etc.  The scan said he was two years behind in terms of actual age.  He made up for it in one summer between ages 15 and 16.  

 

Friends of ours did not pursue the growth hormone therapy for their girls, but did for their youngest son, because it bothered him a great deal.  If I remember correctly, he wound up growing 1 1/2 inches past projected growth.  He was happy with the results.  He did not start the therapy until he was 15, though.  

How is your dd feeling about this?  Is it something she wants to pursue?  

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