What is dwarfism? At present, the standard deviation method and the height percentile method are used to determine short stature clinically.
The incidence of dwarfism has increased in recent years and has attracted the attention of the community. According to a survey conducted by Peking Union Medical College Hospital in 1987, the prevalence of dwarfism among 103,753 primary and secondary school students in the urban area of Beijing was 0.19%, of which pathological dwarfism accounted for 14.3%. In Shanghai, a survey conducted in 2007 among 70,431 primary and secondary school students aged 6 to 18 years in the suburbs showed that the prevalence of dwarfism was as high as 3.77%.
In fairy tales, the seven dwarfs and Snow White live happily in the big forest; however, in real life, there are too many problems caused by short stature. First, the physical and mental development of people with dwarfism is greatly affected. Compared with normal children, although their IQ is within the normal range, they have psychological personality characteristics of introversion and emotional instability; behaviorally, there is poor interaction and social withdrawal. A survey in Shanghai shows that more than 90% of children with dwarfism have different psychological disorders such as low self-esteem and depression, and some children are even reluctant to go to school because they are at the bottom of the class in terms of stature.
In addition, the deficiency in stature also directly affects their education, employment and marriage. Lujarui, who is now employed at Changchun Kinsai Pharmaceuticals and passed the professional eighth grade in English, confided to the reporter the troubles she had experienced, “I was rejected almost at first in elementary school, secondary school, university and in the process of finding a job.”
“Dwarfism seriously affects the physical quality of the nation.” How to promote short stature to grow taller is not only a medical issue, but also a social issue that deserves attention.
The correct understanding of dwarfism The growth and development clinic of Guiyang Children’s Hospital has conducted a follow-up survey on more than 300 cases of children with dwarfism. This can lead to lifelong regrets. According to the survey, at least half of the parents of children with dwarfism think that their children’s height is related to family genetic inheritance, and it is normal for their children’s height to be low because their parents are not tall, so the result is the same whether they are treated or not. A quarter of parents think that if they give their children adequate nutrition every day, they can’t help it if their children’s height is lower than that of their peers.
A survey in Shanghai also found that more than 80% of parents lacked the necessary knowledge about the harm caused by children’s short stature. Many parents do not know that their children’s slow growth is also a disease, and they either leave their children’s height to time or spend a lot of money to supplement their children’s nutrition and use height-enhancing devices, while these blind measures often delay treatment and even backfire.
In fact, dwarfism is a treatable disease, and the first step is to address the cause of the disease. Part of dwarfism is caused by organic diseases, and part of it is caused by non-disease factors. Disease causes include endocrine abnormalities, skeletal lesions or other diseases, among which growth hormone deficiency is the most common, followed by precocious puberty, and some are caused by intrauterine growth retardation or chromosomal abnormalities. Non-disease-induced dwarfism includes familial dwarfism, somatic dwarfism, and delayed physiological puberty development. “Song Yuhang may be due to his mother’s difficult delivery when she gave birth to him, and the birth canal squeezed the pituitary gland resulting in insufficient secretion of growth hormone, causing delayed growth and lagging bone age.”
Second, it is important to seize the timing of treatment. Children with dwarfism are expected to reach normal height as long as they are treated promptly in a regular hospital before the age of 14. If the timing of treatment is missed (e.g. epiphyseal closure), these children will be with dwarfism for the rest of their lives.
Thirdly, techniques should be grasped in the treatment, how to make the gonadal axis develop slower while making the growth axis faster, and promote the height age to catch up with the bone age is the key in the treatment.
Early intervention is important There are two growth spurts in the growth process of children – infancy and prepubescence. The entire process is regulated by a variety of factors, and an individual’s final height is influenced by genetics, birth height, nutrition, hormones, environment, and disease. Among the many factors, growth hormone (GH) plays a decisive role in the entire growth process. One of the more common forms of dwarfism, growth hormone deficiency dwarfism (GHD), is a decrease in growth rate due to insufficient secretion of growth hormone by the pituitary gland, also known as pituitary dwarfism. If GHD is diagnosed, growth hormone replacement therapy is required, and it should be based on the principles of early, timely, adequate and long-term.
Studies have shown that the younger the child is, the more active the growth and differentiation of the cartilage layer of the epiphysis, the greater the growth potential and space, the more sensitive the child is to treatment, and the better the growth effect; moreover, the younger the child is and the lighter the child’s weight, the smaller the dose of medication and the smaller the cost. Therefore, it is important not to wait until the later stages of development, such as 15 to 18 years old, when the epiphysis is close to closure, the growth potential is very small, it is no longer possible to achieve the ideal height. “We often encounter such children in our clinic, they come to the clinic when they are already 16 or 17 years old, we give them a hand bone age film, the film shows that the bones are closed, as doctors we are helpless.”
In comparison, Song Yuhang was lucky; in 2009, at only 136 cm tall, he came to Lianyungang First People’s Hospital and was diagnosed with a complete deficiency of growth hormone. However, his epiphysis had not closed and his bone age was equivalent to that of an 8-year-old child with delayed growth, so there was still hope for him to grow taller. After three months of treatment, his height grew from 136 to 140 centimeters. “The doctor said that if he persisted in the treatment, his height could grow further and eventually break 160 cm.” Speaking of this, he has a happy face.
The maximum effect of growth hormone replacement therapy that can make the eventual height improvement of patients with dwarfism is the first year, and the treatment usually stops after epiphyseal closure, and it is important to stick to the medication during the treatment process, and never use it to stop.
However, since growth hormone is expensive, it is crucial for families with poor economic conditions to apply growth hormone correctly according to the family’s financial ability so that the child’s height potential can be realized.