Short stature in children can cause a lot of distress, especially considering the expectations of our society with peer and family pressures looming large all the time. Short stature should be understood in terms of what should be expected and when you should start worrying and who to go to when you suspect or feel that your child is not growing as he/she should be.
Stature is measured labeled statistically. Just to give an idea, in a group of people, we categorize people that are average, below average and that minority that is above average in terms of height. So when you put that in statistical presentation, it is called percentiles. So, avoiding further jargon, short stature is labeled when the child is below the 3rd centile for height, Which means that out of 100 children of the same age and (ethnicity preferably), 97 children will be having height more than your child if he is at or below the 3rd centile.
Growth dynamics is different in boys and girls. The sex hormones in both have a role to play enclosure of the growth plates of bones in either, which explains why in girls do not increase their height beyond usually 16 years of age (2 to 3 years beyond the onset of their periods). Reason being that girls have an earlier onset of puberty than boys and earlier surges of sex hormones which stimulate growth but at the same time cause earlier fusion of bones so that no further growth is possible beyond a certain age. (Puberty onset in girls 11 plus minus 2 years compared to 12 plus minus 2 years in boys).
The growth of boys usually does not occur beyond 18 years of age when the growth plates fuse. However, when there are certain hormonal deficiencies this fusion does not occur and there is a margin for growth provided the cause is rectified. So when you feel that your child is not growing as he should be or his growth has stopped during the recent times then you should consult with the best Endocrinologist in Lahore, Karachi, Islamabad or any other main city of Pakistan. Sometimes it turns out that the parents are overly concerned and the growth pattern is following the genetics of the family and the child eventually achieves expected height or near it.(This and other factors related to stunted growth explained further in the article). However, we should not be overly concerned nor should turn a blind eye to issues like chronic diseases in a child. Examples being diabetes, bronchial asthma or hypothyroid. These issues when present can affect the growth of the child and eventually lead to a height less than expected. I will briefly go through the factors contributing to growth and disorders which can lead to stunted growth.
So What Influences Stature?
- Genetics And Gender: Gender of the child plays a role in the dynamic’s growth of the child as mentioned earlier. The heights of the father and mother are one of the most important determinants of the final height of the child. So expectations should be based on reality and not ideal benchmarks. An Endocrinologists (docs who deal in disorders related to hormones) can measure the heights of the parents, calculate and show you whether your child is falling within the expected range. Sometimes the growth velocity or the growth which occurs throughout the year may be slow but eventually, it increases and the child ends up near or almost expected height. This is called constitutional delay in growth. This is where there is no specific cause for the delayed growth.
- Environment: Yes, the environment has a role to play. Stress, poverty, malnutrition contribute heavily to the growth of a child. So people living under constant stress, both physical and psychological may end up having stunted growth. Worm infestation due to poor hygiene and living conditions also leads to poor health and can affect height by causing nutritional deficiencies.
- Chronic Diseases: Chronic diseases like bronchial asthma, diabetes, cystic fibrosis and thalassemia, all can contribute to short stature by different mechanisms. One of the mechanisms is the constant stress which the body undergoes, it changes the dynamics of the hormonal balance in the body. This increases surges of the stress hormones namely cortisol which causes stunting by causing earlier closure of growth plates in long bones.
- Hormonal Disorders: The thyroid and growth hormones have very important roles in the growth of a child. And deficiencies of either can cause marked stunting of growth. These hormones are produced by the pituitary gland and both hormones can be deficient in some cases (hypopituitarism). Fortunately, deficiencies of both can be rectified. Thyroid hormone replacement is available and so is growth hormone replacement albeit really expensive.
In a nutshell, short stature is an important issue which is concerned with the future of a child and obviously the parents in a lot of ways and it may also be a tell-tale sign of an underlying disease which eventually may be diagnosed and treated. Expectations should be based on reality and facts. One should not fall prey to people guaranteeing increased in height in the mid-20s or even the 20ths. These false gimmicks are nothing but shenanigans.
So if you feel that your child is not growing as he/she should be, then the right person to visit is an Endocrinologist. And remember, height is just a part of the traits of a human being. if you are told by the doctor that the height cannot be furthered then it’s your job to pick your child up and lift him/her to heights where he/she should be psychologically confident and convince him or her that Life is SHORT AND SWEET, height is not all that matters (obviously the same motivation applies to the parents as well).
Dr. Syed Hunain Riaz
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