For many parents, a child’s growth is quietly tracked over the years – pencil marks on a wall, school uniforms that suddenly no longer fit, shoes replaced every few months.
Growth is more than just a number on a chart, it is one of the clearest signs of a child’s overall health and development.
But what happens when those marks stop moving upward?
When a child seems much smaller than their classmates or outgrows clothes far more slowly than expected, it can raise understandable concern.
One of the conditions a paediatric endocrinologist often evaluates in these situations is growth hormone deficiency (GHD) – a medical condition that, while uncommon, is very treatable.
What is this hormone?
Growth hormone is produced by the pituitary gland, a small, but powerful, organ at the base of the brain often referred to as the “master gland”.
This gland releases hormones that regulate many important body functions, including growth, metabolism and puberty.
Growth hormone is released in pulses, especially during sleep, and plays a central role in stimulating the growth of bones and tissues.
It also signals the body to produce another important substance called insulin-like growth factor-1 (IGF-1), which directly promotes bone lengthening.
In children with GHD, the body simply does not produce enough of growth hormone.
Without it, normal growth slows down significantly.
What causes GHD?
One of the most frustrating aspects for families is that, in many cases, there is no clear answer as to the cause of this condition.
This is known as “idiopathic” GHD.
However, some known causes include:
- Genetic changes (mutations) affecting the development of the pituitary gland
- Structural abnormalities, tumours or lesions of the brain or pituitary gland
- Injuries to the brain or infections, such as meningitis
- Previous radiation treatment or surgery to the brain.
GHD can be present from birth (congenital) or develop later in childhood (acquired).
What to look out for
A child with GHD does not just appear “short”.
There are often subtle, but important, clues.
One of the most significant signs is slow growth over time.
Growth is fastest during the first three years of life and during puberty.
After the age of three, growth slows, but remains consistent – most children grow at least about 5cm per year before their puberty growth spurt.
If growth consistently falls below this, it deserves attention.
Other features may include:
- A younger-looking, cherubic face, compared to peers
- Increased body fat, especially around the abdomen
- Delayed tooth development
- Late onset of puberty.
Importantly, these children are usually otherwise healthy and proportionate, just growing more slowly than expected.
If you are concerned about your child’s growth, the first step is to consult a paediatric endocrinologist, who specialises in children’s hormonal and glandular conditions.
You may want to seek further evaluation for your child if:
- S/he is much shorter than their peers
- Their growth has slowed noticeably
- There has been little or no increase in height over a year.
How it is diagnosed
Diagnosing GHD is not based on a single test; it involves a careful and systematic approach.
Doctors begin by reviewing growth charts, which track a child’s height over time.
A slowing growth pattern is often the first red flag.
Additional tests may include:
- Bone age (a simple X-ray of the hand), which assesses how mature the bones are, compared to the child’s actual age
- Blood tests to measure levels of growth-related hormones such as IGF-1, thyroid and cortisol
- Blood tests to rule out other common causes of poor growth, e.g. nutrition and chronic illnesses
- A growth hormone stimulation test, e.g. glucagon, arginine or clonidine tests, which evaluates whether the body can produce adequate growth hormone when prompted.
If tests confirm GHD, the next critical step is imaging with an MRI (magnetic resonance imaging) scan of the brain and pituitary gland before starting growth hormone treatment.
This is essential because it allows doctors to examine the “structure” behind the problem.
An MRI can reveal:
- An underdeveloped or absent pituitary gland
- Structural differences in the brain
- A brain mass or tumour affecting hormone production – in these rare cases, growth hormone treatment needs to be deferred.
The scan ensures that treatment is both safe and appropriately targeted.
A real-life example
Consider Adam (name changed to protect privacy), a cheerful boy who was born at a normal weight and length.
In his first year of life, everything seemed on track.
He met his developmental milestones and there were no obvious concerns.
However, around the age of three, his parents noticed something subtly different – his clothes seemed to last much longer than expected.
At first, this didn’t seem like a problem, but over time, the difference became more noticeable.
While his classmates were growing taller each year, Adam’s height barely changed.
By the time he was five, Adam was significantly shorter than his peers and often mistaken for a much younger child.
His parents also noticed that he had a “babyish” face and a tendency to gain weight around his tummy despite eating a normal diet.
A medical evaluation showed that his growth rate had fallen well below expected levels.
Further tests confirmed GHD.
An MRI scan revealed that his pituitary gland was smaller than usual.
Adam began treatment with daily growth hormone injections.
Within the first year, he grew more than 10cm – far more than in previous years.
His energy levels improved, his confidence increased, and for the first time in a long while, his parents found themselves needing to replace his entire wardrobe.
How is GHD treated?
The standard treatment for GHD is recombinant human growth hormone, a laboratory-made version of the natural hormone.
This therapy has been used safely for decades and replaces what the body is lacking.
Dose adjustments, supervision and monitoring should be done by a paediatric endocrinologist.
The recombinant hormone stimulates the production of growth factors.
These act on the growth plates in bones, allowing them to lengthen.
Over time, this leads to improved growth.
What treatment involves:
- Daily injections, usually given at night.
Weekly injections are also now approved, but not yet available in Malaysia.
- User-friendly pen devices with very fine needles.
- Regular follow-up every three to six months by a paediatric endocrinologist to monitor progress.
Expected results
One of the most encouraging aspects of treatment is the potential for catch-up growth.
In the first year, children often grow significantly faster than before.
Over time, many achieve a height within their genetic potential.
Beyond height, treatment also supports:
- Bone strength
- Muscle development
- Energy and overall health.
GHD is about more than centimetres.
It affects health, development and confidence during important formative years.
The reassuring news is that with early diagnosis and appropriate treatment, children with this deficiency can do very well.
With support, monitoring and modern therapy, they can grow not just taller, but stronger, healthier and more confident.
Sometimes, those small marks on the wall tell a bigger story, and with the right care, it’s a story that can change for the better.
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.
