Short stature is often a matter of concern for parents, and in some cases, may be caused by a medical condition that can be treated for a return to normal growth. — Positive Parenting
Many parents in Malaysia worry when they notice their child is shorter than their classmates.
Some wonder: “Is my child just a late bloomer, or should I be concerned?”
Height is often a worry for many parents, as it is linked to confidence, sports performance, and even future job prospects.
In some families, shorter stature can also become a topic of discussion among relatives, especially during festive gatherings when comparisons are made.
Some parents may have heard about growth hormone (GH) treatment and wonder if it can help their child to grow taller.
They may also wonder if there any side effects and if it is safe.
If you are considering such a treatment for your child, it’s important to understand:
- Who needs GH therapy (and who doesn’t)
- How it works and what to expect, and
- Whether or not it’s safe for your child.
What is GH treatment?
GH is a naturally-occurring hormone produced by the pituitary gland in the brain.
It plays a key role in growth, bone strength and muscle development.
Some children’s bodies do not produce enough GH, leading to slower growth or short stature.
In these cases, GH therapy can help.
The treatment involves daily injections of lab-made GH, which mimics the natural hormone the body produces.
Who needs it and who doesn’t?
Children who are short due to the conditions below often benefit from GH therapy, which can improve their height outcomes.
This is when the body does not produce enough GH.
It can be due to genetic causes or abnormalities of the pituitary gland.
This is when a child is born small in comparison to other babies their age, and also continues to remain small after birth without any catch-up growth.
These genetic or medical conditions are those that affect growth, e.g. Turner syndrome, Russel Silver syndrome and Prader-Willi syndrome.
Turner syndrome is a genetic syndrome that affects girls and happens when one of their X chromosomes is missing or incomplete.
This can cause short stature, delayed puberty and infertility, along with other possible health issues like heart or kidney problems.
Children who do not need GH therapy include:
- Those whose (bone) growth plates have fused – once bone maturity has been reached, GH will not work.
- Those who are healthy and growing normally along their growth chart (even if they may be on the shorter end of the chart).
How do doctors diagnose GHD?
If a child has significantly slow growth, doctors may perform a series of tests to determine whether GH treatment is needed, and most importantly, to identify underlying health issues.
The tests may include:
- Blood tests – to check hormone levels and rule out other causes of poor growth.
- Growth stimulation tests, e.g. glucagon test – to see if the body can produce GH in response to certain triggers.
- X-ray of the left hand (i.e. the bone age test) – to check if the growth plates are still open.
- MRI (magnetic resonance imaging) of the pituitary gland – to rule out lesions affecting the gland in children with GHD.
As GH levels naturally fluctuate, a single blood test is not enough for diagnosis.
A combination of tests and clinical assessment is needed.
How is GH treatment given?
GH is administered through daily subcutaneous (just under the skin) injections, using a very small needle.
Weekly GH formulations have been approved overseas, but are currently unavailable here.
Older children are often able to self-administer their injections under parental supervision.
Injection sites include the abdomen, thigh and arm.
It is administered at bedtime as GH is naturally released at night, therefore, giving the injection before sleep helps mimic the body’s natural rhythm and maximises effectiveness.
The best growth response usually occurs in the first year of treatment.
Some children may appear leaner as they grow, as GH also helps build muscle mass and reduce fat.
Regular check-ups with a paediatric endocrinologist are essential to track the child’s growth progress, hormone levels, bone age (via X-ray, which is usually done once a year) and overall health.
How long is it needed?
GH treatment is a long-term commitment and may continue for a few years (usually at least two to four years) until the child reaches their final height potential.
Treatment will stop if:
- Final adult height is reached, as indicated by fusion of the growth plates (which is determined by bone age assessment).
- Growth slows to less than 2cm per year.
- The child does not respond well to GH therapy.
As mentioned above, GH treatment will no longer help with linear growth if the growth plates have fused.
Bone age is assessed by a simple X-ray of the left hand and wrist.
In most boys, final height is reached when their bone age is 15-17 years, and girls when their bone age is 14-15 years.
The bone age might differ from the child’s actual age as bone maturation is influenced by various factors, including puberty, hormones and underlying health issues.
Is it safe?
GH therapy is generally safe when used correctly under medical supervision, with side effects being uncommon.
However, possible side effects to watch out include:
- Mild local reactions – e.g. redness, swelling or pain at the injection site
- Joint or muscle pain
- Fluid retention – swelling in the face, hands or feet
- Headaches, nausea or vision problems
- Insulin resistance – leading to an increase in blood sugar levels, which is more common in children who are overweight or at risk of diabetes
- Development of GH antibodies – rare, but can reduce treatment effectiveness.
Certain high-risk groups – e.g. cancer survivors and children with specific genetic conditions – may have additional risks due to their underlying pre-existing medical conditions.
Is it right for my child?
GH treatment can significantly improve growth in some children, but it is not a magic solution for height gain and will not necessarily benefit all children.
It is also essential to remember that GH only works if the growth plates are still open.
If the growth plates have fused, GH will no longer help with height gain.
Regular monitoring with a paediatric endocrinologist is also essential for safe and effective treatment.
Dr Jeanne Wong Sze Lyn is a consultant paediatrician and paediatric endocrinologist. For more information, email starhealth@thestar.com.my. 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.
