Growing concern
Slow growth in children may be a red flag for a medical condition, writes Professor Dr Muhammad Yazid Jalaludin
CHILDREN grow at different rates, with some taller and others shorter. While this is usually normal, parents should know that being too short can be a sign of a significant health problem. Having short parents is one of the most common reasons for a child’s less-thanideal height.
However, if your child is not growing as fast or as tall as other children their age, there is a chance that stunted growth may be the problem.
The World Health Organisation (WHO) categorises children who are stunted as those whose height is shorter than 97 per cent of other children of the same age and gender.
Stunting is often misunderstood as simply being short when poor nutrition or a medical condition is impairing the child’s growth and development.
Stunting affects a large number of children under 5 years old in Malaysia.
At 21.8 per cent, this translates to one in five children under the age of 5 who are stunted. This is three times higher than the seven per cent prevalence among upper middle-income countries.
Over the past decade, stunted growth has become more common among children in Malaysia.
The national prevalence of stunting in children under 5 was 21.8 per cent in 2019, rising from 17.2 per cent in 2006.
Stunting is not an exclusive phenomenon among children from the underprivileged group either.
It happens across income, education levels, occupations and ethnicities.
Even in families with a monthly household income above RM5,000, the prevalence is 17 per cent.
Many parents are not aware that child height is related to nutrition, health or overall growth.
They may attribute their child’s short stature to hereditary or genetic factors or assume that their child will catch up with his or her peers.
HIDDEN ISSUES
Stunted growth is largely irreversible and it is not just about being short.
It can be a red flag for an underlying medical condition that can have a major impact on the overall health and wellness of a child.
Children who are not growing at a normal rate for their age may be afflicted with growth hormone deficiency (GHD).
It is typically suspected when a child exhibits a slower-than-normal growth rate.
GHD occurs when the pituitary gland does not produce enough growth hormones to stimulate height growth and allow a child to grow at a normal pace.
GHD is part of a genetic condition in some children, but in most cases, the cause of the deficiency is unknown.
Children who have this condition are significantly shorter and grow at a slower rate than other children of the same age and gender. They also look very young for their age.
Although a child’s short height is apparent early on, the signs of GHD can be easily overlooked. This is because these children appear to have normal body proportion and look like any other child, albeit with a small stature.
Consequently, children with GHD are often diagnosed late, usually at the age of puberty, when they exhibit a delay in pubertal growth spurt.
At this stage, the child would have already lost the opportunity to benefit from early treatment. This is a serious concern as the health consequences of untreated GHD also extend beyond height.
Growth hormone contributes to other important bodily functions such as maintaining muscle and bone mass, decreasing fat tissues, influencing blood lipid levels such as cholesterol and triglycerides, and regulating cardiac function.
Therefore, children with untreated GHD are at risk of health issues like decreased bone mineral density, high cholesterol, high blood pressure, obesity and heart diseases later in life.
EARLY INTERVENTION
Early recognition of GHD is important to allow affected children to gain maximum benefit from growth hormone treatments.
Hormone treatments help children with GHD attain normal adult height, restore metabolism, enhance body development and reduce the risk of heart disease.
The most common treatment for GHD are daily injections of synthetic growth hormones. An injection pen makes a shallow injection into the fatty tissue just beneath the surface of the skin.
The treatment is carried out over several years until the child achieves a normal adult height or reaches maximum height potential, usually when puberty has completed.
The injection dosage varies with every child, depending on different factors, including the severity of deficiency as well as body weight.
For example, a child will require higher doses of growth hormones as they grow because body weight is increasing.
Children undergoing growth hormone therapy will also need to visit their doctor regularly to monitor the progression of their growth.
Blood tests will be carried out to determine if extra growth hormone is needed and if treatments should be increased, decreased or stopped.
In addition, blood sugar levels (HbA1c), thyroid functions, IGF-1 values and boneage X-rays will also be checked.
Given that growth is connected in many ways to health, a child’s height is often a sign of overall health.
Parents are key players in their child’s healthy growth by being aware and involved in their child’s growth trajectory.
Through regular height measurement, parents can identify the signs of abnormal growth and get their child examined by a paediatrician in time.
Monitoring child height is simple with innovative tools such as smartphone applications that can help parents measure and track their child’s physical growth conveniently.
These applications record a child’s height on a growth chart and compare it with the WHO’s standard for healthy child growth.
Short stature in children should not be disregarded. The earlier GHD is treated, the better their chances of reaching their height potential and preventing health issues that come with the condition.