by Melanie Haiken
CONSUMER HEALTH INTERACTIVE
A growth disorder is an umbrella term for a range of problems that might be preventing your baby or child from growing as fast as would normally be expected.
These problems may include:
In some cases, a growth disorder is a symptom of a disease, such as cancer, heart conditions, and problems with the kidneys, lungs, or gastrointestinal tract, but if this is the case, your child will probably exhibit other symptoms as well. Once in a while, however, a growth problem is the clue that leads doctors to diagnose a more serious illness.
Conditions involving the endocrine system are also likely to lead to growth disorders. If the pituitary gland, a small gland at the base of the brain that secretes a number of hormones, is damaged or malfunctioning, it may not produce enough growth hormone. This condition is known as Growth Hormone Deficiency.
Hypothyroidism, in which the thyroid does not produce enough thyroid hormone, may also affect bone growth. According to Dr. Anthony Karpas, an endocrinologist in Atlanta, Georgia, many children referred to growth specialists turn out to have problems with malabsorption, which means they are not getting the full nutritional benefit from the food they eat. "It's not uncommon for kids to come in who turn out to have milk or gluten sensitivity," says Karpas. "Their growth picks up once they're put on a wheat-free and dairy-free diet."
To pinpoint the cause of your child's slow growth, you may be referred to an endocrinologist, a doctor who specializes in the endocrine system, the body's system of regulating hormones. Your pediatrician or endocrinologist may order a number of tests, including X-rays, blood tests, and urine tests. An MRI of your child's pituitary gland may help determine if it is functioning normally. A bone age X-ray of your child's hands and wrists allows the physician to compare them the hands of other children his age.
In rare cases, children's growth lags as a result of other illnesses or genetic factors. A blood test for chromosomal anomalies can test whether your child has Turner Syndrome, a genetic defect that affects only girls. Other conditions that can cause cause a decline in growth hormone production include chronic renal insufficiency, which occurs when the kidneys cease to function, and thalassemia, an inherited condition which causes severe anemia.
Because growth hormone is produced in spurts, the level of growth hormone in your child's blood is not consistent. This means that in order to check whether your child's pituitary gland is producing adequate growth hormone, your doctor has to perform a series of tests over time. Your child will be asked to fast through the night and then will be given a medication, most commonly arginine, clonidine, glucagons, L-dopa, or insulin, to force the pituitary gland to secrete growth hormone. Your child's blood will then be tested over a period of several days to determine the level of growth hormone. Since most growth hormone is produced while your child is asleep, another way to test the quantity of growth hormone is to hospitalize your child overnight and then take blood samples during a 24-hour period.
If no cause is found for your child's small size, this is known as "idiopathic" growth disorder.
Interview with Anthony Karpas, MD Endocrinologist in private practice, Atlanta, Georgia
Interview with David Sandberg, Professor of Pediatric Psychiatry and Psychology
Reviewed by Niki Saxena, M.D., a pediatrician practicing in the San Francisco Bay Area.
Last updated October 29, 2009
Copyright © 2003 Consumer Health Interactive