Impaired Growth and Development

Overview

Stunting is the delayed growth and development that children experience as a result of poor nutrition, frequent infection, and insufficient psychosocial stimulation. Stunted children are those having height-for-age more than two standard deviations below the WHO Child Growth Standards median.

Stunting in early life, particularly during the first 1000 days from conception to the age of two, has a negative functional impact on the kid. Poor cognitive and school performance, low adult wages, lost productivity, and, when combined with excessive weight gain later in childhood, an increased risk of nutrition-related chronic illnesses in adulthood are some of the effects.

Linear growth in early infancy is a powerful indicator of healthy growth because to its link with morbidity and mortality risk, non-communicable illnesses later in life, and learning ability and productivity. It is also closely related to child development in various areas, including cognitive, linguistic, and sensory-motor skills.

How Common Is Growth & Development Impairment in Children?

Growth issues is a wide term that refers to a variety of disorders that affect your child's insufficient growth.

About 3 to 5% of children are classified short, which means their heights are below the third or fifth percentiles on a growth chart. Many of these children have at least one short parent, and just a few have a distinct and curable medical growth issue.

A growth issue may be obvious at birth if your child is unusually small for his age, or it may become apparent if he remains undeveloped in comparison to his peers.

A child is considered to have growth delay if he is little for his age but grows for a longer period of time than other children, eventually attaining a normal height.

How Is Normal Growth Defined?

"Normal" growth in height is defined as:

0 to 12 months: around 10 inches. Growth during this stage is mostly determined by diet.
1 to 2 years: around 5 inches. Hormonal elements play an increasingly essential influence in your child's growth beginning at the age of one.
2 to 3 years: around 31/2 inches each year.
3 years till puberty: around 2 inches every year. Until adolescence, there is little variation in development between boys and girls, resulting in an average height difference of 4 to 5 inches between the sexes.

When Being Short Is Normal?

If you look around a preschool class, you'll see a wide range of heights, although most children are likely to be within the typical range. When looking at a growth curve, the 50th percentile implies that if you have 100 children, 50 will be taller than that line and 50 will be shorter.

The difference in height between a four-year-old boy in the third percentile and one in the 97th percentile, according to the World Health Organization growth chart, is 16 cm (or just over half a foot). When you consider that there will be a range of ages in a class, some children will certainly tower over others.

However, the majority of your child's height is determined by genetics. When you have two parents who aren't particularly tall, you don't expect your child to be extremely tall and, while many people believe that the size of their kid at birth predicts the future, this is not the case. It is changed by early delivery or various variables that influence growth in utero, such as maternal diet or maternal stress.

Your child's adult height might vary. Some children have "constitutional growth delay," which means they reach puberty (and the concomitant growth spurt) later than their classmates. Even as toddlers, children might exhibit signs of being "late bloomers.". What happens is that the bone-age structure is younger than the chronological age. Even a two-year-old may have bone age similar to a one-year-old."

Though the symptoms are present if you search for them, physicians usually don't detect this disease until the child reaches puberty, when the youngster is simply so far behind their classmates that it's just a question of waiting for their growth spurt. They gradually catch up and achieve adult size. They're the kid who goes away for the summer between grades 11 and 12 and returns a foot taller.

What Causes Growth Problems?

Growth problems can be caused by a number of factors, including genetics, hormonal disorders, systemic illnesses, malnutrition and poor absorption of food. Causes of growth problems usually fall into the following categories:
Familial short height, a proclivity to acquire small stature from one's family (shortness).
Delay in constitutional growth, often known as delayed puberty. A youngster with this syndrome approaches puberty later than typical, yet grows normally. Most of these kids will ultimately reach the same height as their parents.
Disorders affecting the whole body, often known as systemic or chronic illnesses, or illnesses affecting the digestive tract, kidneys, heart, or lungs.
Malnutrition, constant malnutrition stops a child from growing as tall as she could; a well-balanced diet avoids or corrects this in most cases. Malnutrition is the leading cause of growth failure worldwide.
Endocrine (hormone) diseases, such as diabetes or a lack of thyroid hormones, which are necessary for normal bone growth.
Syndromes (genetic disorders), Cushing's syndrome, Turner syndrome, Down syndrome, Noonan syndrome, Russell-Silver syndrome, and Prader-Willi syndrome may all have growth issues.
A lack of growth hormone, the pituitary gland (a tiny gland near the base of the brain that secretes various hormones, including growth hormone) malfunctions in a kid with this development disease.
Problems in the tissues where growth occurs that are congenital (existing at birth).
Restriction of intrauterine growth (IUGR), the delayed growing of a fetus within the uterus causes this syndrome. In relation to his tiny stature, the infant is born with a smaller weight and length than usual.
Anomalies in chromosomes, having too many or too few chromosomes can cause health issues, including growth issues.
Skeletal abnormalities, there are more than 50 bone diseases that affect height and growth, many of which are genetic. The most common is achondroplasia, a type of dwarfism in which the child's arms and legs are short in proportion to his/her body length. The head is often large and the trunk is normal-sized.
Precocious puberty, this growth disorder is characterized by an early onset of adolescence in which a child is tall for his age initially, but due to rapid bone maturity, growth stops at an early age and the child may be short as an adult.
Genetic conditions, there are a few genetic conditions that result in tall stature, where other health problems are also present.
Idiopathic, there are several growth disorders that are idiopathic, meaning that there is no known cause for the growth problem.

Symptoms of Growth & Development Problems

Most growth abnormalities are discovered when a child seems smaller than their peers or when growth slows over time. Slower height growth than planned each year is one of the most obvious signs of a growth disorder. This equates to yearly height growth of less than 2.2 inches (5.5 cm) between ages 2 and 4, less than 2 inches (5 cm) between ages 4 and 6, and less than 1.6 inches (4 cm) for boys and less than 1.8 inches (4.5 cm) for girls. In some situations, a baby's gestational age at delivery may be excessively small.

Growth problems may be part of other problems or health conditions. Make sure your child sees their healthcare provider for a diagnosis.

Symptoms of Growth Hormone Deficiency

Children with GHD are shorter and have younger, rounder faces than their classmates. Even if their body proportions are normal, they may have "baby fat" around the belly.

If GHD occurs later in life, such as as a result of a brain injury or tumor, the predominant sign is delayed puberty. Sexual development is interrupted in some cases.

Many children with GHD have poor self-esteem as a result of developmental abnormalities, such as small height or a sluggish rate of maturation. Young women, for example, may not grow breasts, and young men's voices may not develop at the same rate as their peers.

Reduced bone strength is another symptom of AGHD. This may lead to more frequent fractures, especially in older adults.

People with low growth hormone levels may feel tired and lack stamina. They may experience sensitivity to hot or cold temperatures.

Those with GHD may experience certain psychological effects, including:

Depression.
Lack of concentration.
Poor memory.
Bouts of anxiety or emotional distress.

Children with AGHD have excessive amounts of fat in their blood as well as high cholesterol. This is due to changes in the body's metabolism induced by low amounts of growth hormone, not a bad diet. Children with AGHD are more likely to develop diabetes and heart disease.

How Are Growth & Developmental Problems Diagnosed in Children?

When a baby is excessively small for their gestational age, a growth issue may be discovered at delivery. In other circumstances, a growth issue may be discovered when a child's development is assessed during regular check-ups.

Your child's healthcare practitioner must make the diagnosis of a growth issue. They could collaborate with a paediatrician. The healthcare practitioner will inquire about your child's symptoms and medical history. They may also inquire about your family's medical history and do a physical assessment. Your child's health and growth may be monitored for several months.

Your child may also have tests, such as:

Blood tests. These are done to check for hormone, chromosomal, or other disorders that can cause growth problems.
X-ray. A little quantity of radiation is used in this test to create pictures of tissues inside the body. An X-ray of the left hand and wrist may be taken. This may be used to calculate your child's bone age. In cases of delayed puberty or hormonal imbalances, bone age is frequently smaller than calendar age.

Supporting Your kids

If your child's paediatrician is worried about his or her growth rate, you might expect a few additional doctor's appointments as they monitor the growth to see if it improves. The doctor will inquire about the heights of your family members to see whether there is a family history of shortness. Sometimes those genes go latent for a while, and one lucky child inherits them a few generations later.

They'll inquire about when both parents went through puberty, as well as nutrition and food, to see if there's an underlying problem. They may request blood tests to screen for chronic diseases or thyroid problems, as well as an X-ray to determine bone age. In some situations, you may be sent to a paediatric endocrinologist, who may order an HGH test.

Whether there is an issue or not, never make your child feel as if there is anything wrong with them because of their height. By all means, ask the questions and, if necessary, seek medical treatment. However, if you've been informed that everything is okay, don't be concerned about their size. It is more preferable to be healthy and normal, but short, than to deal with all of the additional medical difficulties that come with receiving therapy for various reasons. Some children are destined to be smaller, while others are destined to be taller. We should focus on our children's strengths and boost their confidence as long as they are healthy.

Treatment of Growth & Development Impairment

The cause of your child's delayed growth will determine their treatment approach. Doctors often do not recommend treatments or interventions for slowed development caused by a family history or constitutional delay.

For other underlying reasons, the medicines or procedures listed below may assist them in resuming normal growth.

Hypothyroidism.

To compensate for your child's underactive thyroid gland, your doctor may give thyroid hormone replacement drugs. The doctor will monitor your child's thyroid hormone levels on a frequent basis during therapy. Some children grow out of the disease on their own after a few years, but others may require care for the remainder of their lives.

Turner syndrome.

Even while children with TS naturally create GH, their bodies can utilise it more efficiently when it is supplied by injection. Your child's doctor may consider starting daily GH injections at the age of four to six to boost their chances of achieving normal adult height.

Similar to the treatment for GH deficiency, you can usually give the injections to your child at home. If the injections aren’t managing your child’s symptoms, the doctor can adjust the dosage.

Growth hormone deficiency.

Synthetic growth hormones have been used successfully to treat children and adults since the mid-1980s. Natural growth hormones from cadavers were employed for therapy prior to synthetic growth hormones.

Growth hormone is often administered through injection into the body's fatty regions, such as the back of the arms, thighs, or buttocks. It works best as a daily therapy.

Side effects are generally minor, but may include:

Redness at the injection site.
Headaches.
Hip pain.
Curving of the spine (scoliosis).

Long-term growth hormone injections may contribute to the development of diabetes in rare situations, particularly in persons with a family history of the illness.

Children with congenital GHD are frequently treated with growth hormone until puberty. Children who have too little growth hormone in early childhood often begin to make enough when they reach maturity.

Some, however, continue in treatment for the rest of their lives. By monitoring hormone levels in your blood, your doctor can evaluate if you require recurring injections.

There are more underlying reasons than the ones mentioned above. Other therapies for your child's delayed growth may be offered depending on the cause. Talk to their doctor about how you may help your child attain a typical adult height for additional information.

Outlook for Children With Delayed Growth

Your child's outlook will be determined by the reason of their development delay and the timing of therapy. They may achieve normal or near-normal height if their issue is recognized and treated early.

If they wait too long to begin therapy, they may have low stature and other issues. They will stop growing after the growth plates at the ends of their bones have closed in young adulthood.

Inquire with your child's doctor about their individual disease, treatment strategy, and outlook. They can assist you in understanding your child's prospects of achieving a normal height as well as their risk of issues.

Conclusion

A growth issue occurs when a child's growth goes below or beyond the usual range for his or her age, gender, family history, or racial background.

Most growth abnormalities are discovered when a child seems smaller than his or her peers or when growth slows over a period of months. When a child grows fewer than 3.5 cm (approximately 1.4 inches) a year after his or her third birthday, this is a symptom of a growth issue. In some situations, a baby may be born abnormally tiny for his or her gestational age.

Other diseases or health concerns may cause growth difficulties. Make an appointment for your child to visit a doctor for a diagnosis.

Many disorders that cause growth issues can be controlled or cured medically. Treatment for growth issues will be dependent on the following:

What may be causing the growth problem?
How severe the problem is.
The child's current health and health history.
The child's ability to deal with medical procedures and take medicines.
The parents’ wishes about treatment.