My teenage boy is not growing tall

Although parents may worry, many short and healthy boys are late bloomers.

One of the most common concerns of parents is on growth issues, particularly adolescents.

Height is often a significant indicator of a child’s overall health and well-being, and deviations from the expected growth trajectory can raise questions and sometimes alarm.

Today, I’m going to delve into the topic of adolescent boys who are short, exploring whether they are late bloomers, or if there could be underlying medical conditions such as growth hormone deficiency (GHD).

Variations in growth

Adolescence marks a period of rapid growth and development, characterised by significant hormonal changes.

Boys typically experience a growth spurt around the age of 12 during puberty, with growth rates varying individually.

It’s essential to recognise that there is a wide range of normal growth patterns among children, influenced by genetic factors, puberty, nutrition, overall health and environmental factors.

Late bloomers

The term “late bloomer” is often used to describe children who experience delayed growth and puberty compared to their peers, but eventually catch up during puberty and achieve normal adult height.

In medical terms, it is known as constitutional growth delay.

These children may initially be shorter than their peers.

They also often experience a period of slower growth just before puberty but eventually catch up with puberty and reach their genetic potential for height.

Late bloomers usually do not have underlying medical conditions affecting growth; rather, their growth patterns are considered normal variation.

Some characteristics of late bloomers are:

> Late start to puberty

Late bloomers enter puberty later than their peers.

For boys, this means they might not develop facial hair, a deeper voice, testes, genitalia and pubic hair development until after the age of 14.

> Delay in growth spurt

Late bloomers begin their growth spurt later than other kids because their puberty starts later.

While many boys grow quickly between ages 12 and 14 during the average age of puberty, late bloomers might start this growth phase closer to 14 to 16 years.

> Shorter at first

Before their growth spurt kicks in, late bloomer boys might seem shorter than their peers of the same age.

This can worry parents who notice their child isn’t growing as fast as others.

> Catching up in growth

As late bloomers enter puberty, they will go through a growth spurt and then catch up in height compared to their friends.

> Family traits

Late bloomers often have family members who also started puberty late and grew later than others e.g. father might only have started puberty after the age of 14.

When to see a doctor

While many short healthy boys are late bloomers, it’s crucial to be vigilant for signs that may indicate an underlying medical condition such as GHD.

These two conditions can be hard to differentiate at first.

GHD occurs when the pituitary gland in the brain does not produce enough growth hormone, which can result in stunted growth if left untreated.

Here are some indicators that warrant medical evaluation:

> Consistently below average growth

Boys whose growth consistently falls below the third percentile on growth charts or whose growth velocity (rate of growth) is significantly slower.

> Delayed puberty

A delay in the onset of puberty (typically no signs of puberty by age 14 in boys).

> A poor final height prediction

The predicted final height can be estimated from a bone age, which is measured via a simple x-ray of the left hand.

Certain medical conditions can also affect growth during adolescence.

These should be excluded before labelling a boy as a late bloomer.

They include:

> Nutrition and diet

Adequate nutrition is crucial for healthy growth during adolescence.

A lack of essential nutrients, such as proteins, vitamins, and minerals such as vitamin D and calcium, can hinder growth potential.

However, the child’s weight is often more affected than his height.

> Chronic iIllnesses

Conditions such as thalassemia, inflammatory bowel disease, kidney disease, heart conditions or long-term usage of certain medications can affect growth.

> GHD

> Other endocrine disorders

Disorders affecting other hormones, such as thyroid hormone or sex hormones, can also impact growth and puberty.

> Environmental factors

Exposure to toxins, chronic stress, child abuse, severe neglect or socio-economic conditions can influence growth patterns.

There are a lot of factors that determine if your child will indeed end up shorter than his peers; more importantly, parents should encourage the child to be healthy and strong. — Photos: Pexels

Diagnosis and treatment

If there are concerns about a child’s growth, a paediatric endocrinologist will conduct a thorough evaluation, which may include:

> Physical examination

Assessing growth patterns, body proportions, and signs of puberty.

> Growth charts

Plotting height measurements over time to assess growth velocity.

> Blood tests

Testing to exclude other health or hormonal issues.

> Bone age x-ray

Evaluating bone maturation to assess growth potential.

Boys who are late bloomers often do not need any treatment.

For some boys who experienced significant psychological distress, a short duration of sex hormones therapy might be given to accelerate the start of puberty.

Any bullying in school must also be addressed.

If GHD is diagnosed, treatment typically involves synthetic growth hormone injections, which can effectively stimulate growth and help children achieve their genetic height potential.

Early diagnosis and intervention are important for optimising treatment outcomes.

It is also crucial to appropriately manage any underlying medical condition.

Parents, calm down

Parents often worry about their child’s growth and may feel anxious if their child is shorter than his peers.

It’s essential for healthcare providers to communicate openly with parents, providing education about normal growth patterns, variations and potential medical conditions.

Encouraging primary healthcare providers or parents to track their child’s growth on growth charts and to discuss any concerns promptly can facilitate early intervention if necessary.

Our society places significant importance on height, which can pose challenges for children who are shorter than their peers.

They may encounter difficulties as playmates, teachers and even parents themselves sometimes treat them as younger rather than simply smaller.

Consequently, these children may not be expected to act their age, leading to potential issues with self-perception and social interaction.

Teasing and name-calling can exacerbate these challenges, making it crucial to address them openly and honestly with teachers and classmates.

Hence, it is also essential to provide emotional support and highlight a child’s many positive qualities, encouraging the child to be healthy and strong instead of focusing on his lack of height.

In conclusion, while many healthy adolescent boys who are short are late bloomers and will eventually catch up in height, it’s vital to consider and evaluate those who may have underlying medical conditions such as GHD.

If there are concerns about significantly delayed growth or puberty, early consultation with a doctor, such as a paediatrician or paediatric endocrinologist, can provide guidance and appropriate evaluation.

Dr Jeanne Wong Sze Lyn is a consultant paediatrician and paediatric endocrinologist. For more information, email [e-mail]. The information provided is for educational purposes only and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.