All parents want their children to grow tall. But sometimes it is seen that the child is growing, but not to the desired extent. Why is that?
Whether the child is short or not, according to age, must be understood first. For this, note whether it is growing less than the children of the same age. Physical examination and measurements should be done at every vaccination from the first year (once at 6 months, every 6 months from 1 to 8 years) to know the proper growth of the child. Then this should be done once a year.
Children normally grow taller in the first 3 years after birth and later in adolescence. Thus, girls attain the desired height at the age of 15 and boys at the age of 17. On average, babies grow 2 inches a year during the middle period. If there is an exception to this, a doctor should be consulted.
In the beginning, the doctor will measure the child’s height and verify it with a specific growth chart to determine whether the child is short or not. If the child is short for his age according to the growth chart, then the reason should be investigated.
There are two main causes of stunting in children: physical and pathological. Apart from this, in some cases, it is not possible to determine the cause of the deficiency. Let’s find out the reasons:
Poverty due to family reasons
Family height is the root cause of stunting in 23 to 37 percent of cases. The height of these children falls below the accepted growth chart but is normal according to the parents’ height. They usually do not suffer from any other diseases, grow at a certain pace, and eventually stay within the family height range.
Medical scientists are constantly researching ways in which familially short children can grow taller. In most cases, they did not have very promising results with growth hormone.
Apart from that, growth hormone is also very expensive. However, those whose genetic studies are not too negative, who are not consistently short in the family, and whose bodies are found to have partial growth hormone deficiency or IGF-1 deficiency may benefit from growth hormone treatment.
In addition, since growth hormone therapy is approved for the treatment of stunted children (idiopathic short stature) of unknown cause, there are precedents for treating stunted children for some familial reasons. But the decision of the expert doctor is the last thing to consider in all this.
Malnutrition
Malnutrition is one of the main causes of child stunting in our country. Chronic undernutrition has many causes, including economic status, education, maternal health, birth weight, housing, immunization, etc. These children are underweight compared to their height.
Appropriate remedial action should be taken. Adequate nutrition and other measures should be taken to increase the height of malnourished children, as per the advice of expert doctors.
Atrophy due to delayed puberty
This is also a physiological factor. These children grow at a normal height for the first one to two years after birth, then fall slightly below the accepted growth chart. They usually do not suffer from other diseases, grow at a certain pace, fall slightly behind other children during puberty, but eventually reach normal height.
This happens because they have delayed puberty, and there may be a family history of it. To identify this problem, the doctor will maintain the growth chart of the child and the family and make the correct diagnosis subject to the necessary tests to know if there is any other cause or age-related disease.
Since this is also a physiological problem, most cases do not require treatment. Although these children attain their desired height with a little delay, to get this normal height, proper hygiene must be followed, and regular medical supervision is required.
However, in some cases, the puberty process may need to be accelerated with medication, and in rare cases, permanent delayed puberty may require treatment.
Low-birth-weight babies
These children do not grow properly in the mother’s womb for many reasons, including malnutrition, illness of the mother, and problems of the child. A large proportion of children who are born with low weight and length without complications or congenital diseases regain normal height within two years with postnatal care and treatment.
For the remaining 10 to 15 percent who do not achieve the desired height within 3 to 5 years, growth hormone therapy is internationally approved to treat them.
Genetic syndromes and metabolic defects
Children with Down syndrome, Turner syndrome, Noonan syndrome, Cushing syndrome, Prader-Woolly syndrome, Russell-Silver syndrome, etc. have short stature. Among these, growth hormone therapy is internationally approved for Turner syndrome, Noonan syndrome, and Prader-Woolly syndrome. Some diseases, including mucopolysaccharoidosis, cause children to be short when there are defects in the metabolism of various food components. Treating that specific disease may yield some results.
Depression is a mental illness
Mental illness in children is often overlooked. However, this mental illness can cause many problems, including depression. In mental illness, the secretion of growth hormone decreases, the opposite hormone increases and caloric intake decreases. As a result, the child does not grow to normal height. Therefore, along with the physical health of the child, mental health is very important.
Weakness due to medication
Long-term use of drugs that affect growing bones can cause stunting in children, including steroid drugs and chemotherapy and radiotherapy used to treat cancer. Adequate attention should be paid to the adequate growth of the child while using these medicines.
Dr. Ravi Biswas, Associate Professor, Child Hormone Pathologist, Dhaka Children’s Hospital
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