Dr Praveen Ramachandra
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   Home      Education on growth related problems


Growth disorders are problems that prevent children from achieving normal height, weight or sexual maturity.  Just because the child is not developing at the same rate as his or her friends is not always a cause for concern. Some children may be small for their age but still develop normally. Some children are short or tall because it comes as a result of heredity.  Some children mature at a different rate than others.

Fig 1: Growth level of children with same age

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  •        Short stature:  That is when the child is significantly shorter than the kids of the same age and sex. This is usually due to a family’s genetic makeup and is not considered a growth disorder. Short parents tend to have short children.
  •        Constitutional growth delay: It occurs when kids are small for their age but grow at a normal rate. These children tend to reach puberty and other developmental milestones later than their friends. Because they also grow until an older age, they usually catch up with peers. These “late bloomers” do not have a growth disorder either.

Short parents tend to have short children. This is related to a family’s genetic makeup. Because children usually grow to about the same height as their parents, this is not considered to be a growth disorder. 

However, because they may be short, or may not enter puberty when their peers do, some children may need extra help coping with teasing, or they may need reassurance that they will eventually go through full sexual development.

 Some children, however, do have growth disorders. Very slow or very fast growth can signal an overactive or underactive gland or another disease. The growth disorders include the following symptoms:

  •         Children who are at or below the 3rd or at or above the 97th percentile on the growth chart may have a growth disorder
  •         The child grows less than 2 inches per year after reaching the age of 3
  •         The child is much shorter than peers of the same age and gender
  •         The short child may be "chubby," with otherwise normal proportions
  •         The child's face may look younger than other kids of the same age and gender
  •         An older child reaches puberty much later than peers (or at all, depending on the disorder)
  •         A failure to thrive may also be a sign of an underlying growth disorder


Disorders of Puberty and Sexual Development

The gonads are the main source of sex hormones in both males and females. In males, they are called testes, which secrete androgen hormones such as

testosterone. In girls, the ovaries produce eggs and secrete hormones including estrogen. Normally, these hormones help regulate the body changes 

associated with puberty. Sometimes, a lack or abundance of these hormones can either delay or accelerate puberty and growth.


·        Delayed puberty is defined as the lack of any signs of puberty by age 14 in either sex. Most often, delayed puberty is a result of constitutional growth delay. Sometimes, a medical condition can delay puberty. Chronic illnesses such as diabetes, cystic fibrosis, kidney disease or asthma can all cause puberty to occur later on. Malnourished kids may have delayed puberty as well.

·        Precocious puberty is when there are signs of secondary sexual maturation before 8 years of age in girls and 9 years of age in boys. In girls, signs of precocious puberty might include breast growth and a first period. Boys may have enlarged testicles and penis, facial hair and a deepening voice. Both boys and girls may have pubic or underarm hair growth, acne, and body odor as well. Causes might include ovarian cysts in girls and certain tumors in both girls and boys. Exposure to certain creams and ointments containing estrogen or testosterone might also trigger precocious puberty.


Endocrine Disorders

The endocrine system is made up of glands that secrete hormones into the circulatory system. If something goes wrong, it can affect a child's growth. Endocrine disorders associated with growth include:

  • Growth hormone (GH) deficiency: It occurs when the pituitary gland does not secrete enough Growth Hormone (GH). This condition may be present at birth (congenital) or the result of a medical condition or severe brain injury. Most often, the cause is unknown. GH is needed for normal growth, muscle and bone strength, as well as proper distribution of body fat. It also aids in the control of sugar and fat levels. Without enough GH, a child is likely to grow slowly and be much shorter than other children of the same age and sex. The child with a GH deficiency will have a slow, or flat, rate of growth. Symptoms, including slow growth, may be noticed from infancy through 2 or 3 years of age.

Fig 2: Growth hormone deficiency/ over production

  •        Hypoparathyroidism: It is a calcium disorder related to the parathyroid. The parathyroid secretes the parathyroid hormone (PTH), which helps to balance calcium and phosphorous in a child's body. Hypoparathyroidism can lead to juvenile osteoporosis and delayed growth.


  •        Hypothyroidism: Hypothyroidism or an underactive thyroid occurs when the thyroid gland (a gland located in the neck) doesn’t produce enough of certain hormones. As with hypoparathyroidism, it can cause delayed growth in kids. Also their arms and legs may be short in proportion to the rest of the body. They may not develop teeth when expected.


Congenital Growth Disorders

Congenital disorders are those present at birth. Many congenital growth disorders are genetic and include:

·        Congenital adrenal hyperplasia, which prevents the body from making enough cortisol. Children born with congenital adrenal hyperplasia may have other hormone imbalances that affect growth.

·        Turner syndrome, which is a genetic disorder that occurs in girls. Girls with Turner syndrome are short and usually have an abnormal puberty.

Fig 3: Signs and symptoms of Turner syndrome


·        Klinefelter syndrome occurs when a boy is born with an extra Y-chromosome (boys normally have one X- and one Y-chromosome). Boys with Klinefelter syndrome may have long legs and a short trunk, along with some sexual symptoms.

Fig 4: Signs and symptoms of Klinefelter syndrome


·        Androgen insensitivity syndrome (AIS) occurs when a child has one X- and one Y-chromosome, as a boy does, but the body doesn’t process, or is resistant to, male hormones. This results in a child with mostly female physical characteristics, but the genetic makeup of a male.


When to see a doctor

It is better to consult the doctor when you find the above symptoms in your child.