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by Steven Leichter, MD
My son is 4-years-old and tiny compared to the other kids in his preschool. His pediatrician says he’s fine, but I’m still worried. How can I be sure nothing is really wrong?
A perception that a child is significantly below the height for the range of his classmates is an important concern that should be evaluated.
An initial screening can determine if there is a real growth problem and whether it is traumatic or dangerous. This screening will let parents know whether there is really nothing to worry about or whether more serious consideration should be given to the issue.
If it is determined that there is a real problem, which is harming the growth of a child, many of these issues can and should be treated. In general, the earlier that treatment is instituted, the better the long-term outcome. Some issues that cause decreased growth can be caused by problems for which diagnosis and treatment should not be delayed, as delay can really harm the child, although, fortunately, these issues are not very common.
Initial screening and early treatment are especially critical for one important cause of growth issues in children: a deficiency of growth hormone. Growth hormone is secreted by the pituitary gland, and it is the primary hormone that stimulates growth.
If a child is found to be deficient in growth hormone, the child can be treated with growth hormone injections, which will make the growth patterns normal again. But the longer treatment is delayed, the less impressive the results since growth hormone is a slow-acting hormone. Children can only grow linearly until they reach puberty, at which point, the secretion of sex hormones completes growth. If treatment is not instituted until the child is close to puberty, the time to grow is then very limited, and the child enters adulthood shorter than they should.
Deficiency of thyroid hormone is another example of curable growth problems that should be evaluated and treated quickly. This deficiency will also decrease growth rates, but if a child is left hypothyroid for too long, the child’s intelligence may be affected. Therefore, evaluation should definitely not be delayed.
We suggest that any parent, who is concerned about growth problems in their child, consult the pediatric endocrinologist in our center as soon as the concern seems important to the parent.
Dr. Leichter is a nationally recognized and board certified internist and endocrinologist. He serves as the medical director for Endocrine Consultants, The Center for Diabetes and Metabolism in Columbus.
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