Child Growth and Development Assessment

When to seek an assessment

Children's growth and development are important to many parents. Short stature, clinically often defined as height below the 3rd percentile for children of the same age and sex, can result from multiple factors. If growth delay is suspected, seek professional medical advice for assessment and investigation.

Common causes of short stature

Non-pathological factors (the majority)

• Familial short stature: When parents are shorter, a child's genetically determined growth curve may be lower while development progresses normally.\n• Constitutional growth delay: Often described as being a “late bloomer”. Bone age is usually younger than chronological age; although a child may be shorter in early years, puberty comes later and final adult height can often reach the expected range.

Pathological and endocrine factors

• Growth hormone deficiency (GHD): The pituitary gland does not produce enough growth hormone.\n• Idiopathic short stature (ISS): Height is clearly below the usual range without an identifiable cause.\n• Genetic and chromosomal conditions: Such as Turner syndrome and Prader-Willi syndrome.\n• Other systemic conditions: Chronic kidney disease, poor gastrointestinal absorption, long-term malnutrition, or use of certain medicines such as corticosteroids.

Growth hormone treatment

Growth hormone injection is one treatment that may help increase height. Growth hormone replacement therapy may be appropriate for children with growth hormone deficiency or growth delay. The aim of treatment is to help a child reach the best possible adult height, following an individual medical assessment.

How growth hormone is given

• Method and route: Given by subcutaneous injection, similar to an insulin injection, into fatty tissue such as the abdomen, thigh, or upper arm. Modern injection pens use very fine needles and discomfort is usually low.\n• Frequency: Traditional preparations are injected once daily before bedtime, when the body naturally releases more growth hormone during sleep. Some long-acting preparations are given once weekly.\n• Best treatment window: Treatment needs to begin before the growth plates close, usually before the end of puberty. Once growth plates have closed, additional growth hormone cannot increase height.

Expected effect

• Response varies: The effect of growth hormone depends on the underlying cause. Children with growth hormone deficiency usually have the most marked response; results vary for idiopathic short stature and chromosomal conditions.\n• Final adult height: With regular treatment over several years, some children may gain several to more than ten centimetres in final adult height. A doctor should assess and estimate the likely individual benefit.

Side effects and risks

Growth hormone is generally safe when used under medical supervision. When treatment follows a doctor's instructions, side effects are uncommon, but ongoing monitoring is important.

1. Local injection reactions

Redness, bruising, pain, or loss of fat tissue at the injection site. Injection sites should be rotated regularly.

2. Fluid retention and joint pain

Mild swelling of the hands or feet, joint pain, or muscle aches may occur, most often early in treatment.

3. Headache and raised intracranial pressure

Rarely, benign intracranial hypertension may cause severe headache, nausea, or blurred vision.

4. Blood sugar and metabolic effects

Growth hormone can reduce insulin sensitivity and raise blood sugar, so blood sugar may need regular monitoring.

5. Bone and joint concerns

Rapid skeletal growth may cause or worsen scoliosis, and in rare cases may be associated with slipped capital femoral epiphysis.