There are a few children whose growth has stalled at an age when they should be developing, and no corresponding changes in sexual development occur, which is called growth delay and growth disorder. Delayed growth means that the child’s growth is delayed but eventually reaches a normal level, while growth disorder means that the normal growth process is interrupted and cannot develop again without treatment. What is hereditary dwarfism Some children have normal growth changes, are well-proportioned, show significant growth spurt, have well-developed sexual organs and secondary features, and their only physical sign is their short stature. These children are completely healthy and normal, and their short stature is caused by family genetic factors, since their parents have a significantly lower average height and most of their siblings are also short. They do not need any treatment and growth stimulation with growth hormone or androgens is completely ineffective because their own and their parents’ hormone levels are completely normal. What is physiological delay in puberty? Some children are born with normal length and weight, but their growth rate is slow. By 13-14 years of age, when other children have begun to grow suddenly, they are still only the height of a normal 8-9 year old; their bone age is also delayed, and the degree of delay is consistent with the delay in height. These children are also generally 3-4 years late in pubertal development. Such growth delays are due to genetic factors, and various growth and sexual development delays are often present in the child’s parents or relatives. Any child with a physical delay in puberty develops at a slow pace but is well-proportioned, which can be distinguished from many children with other endocrine disorders. There is short-term treatment with androgens (testosterone, etc.), but it is best not to abuse them because they both promote sudden growth increases in height and accelerate epiphyseal healing at the same time, and often have a greater effect on the latter. Therefore, because the early healing of epiphysis limits the process of height growth, the final height will be reduced instead. Endocrine abnormalities and growth disorders There are two most common endocrine causes that affect growth, namely growth hormone deficiency and thyroid hormone deficiency. Most growth hormone deficiencies are idiopathic and only a few are secondary to intracranial lesions, such as craniopharyngioma, which are mostly benign and can be surgically removed. The incidence of idiopathic growth hormone deficiency is about 1 in 10,000 and is hereditary, with a male to female ratio of about 4:1. These children are short in stature, with severe cases of dwarfism, but their intelligence is generally in the normal range. The use of growth hormone in these children can be effective, but the treatment period is long (from childhood to adolescence, with 2-3 intramuscular injections per week) until the growth stops naturally. If the child also has other pituitary hormone deficiencies, they should be treated symptomatically at the same time. Lack of thyroid hormone can also cause growth to stop. Because thyroid hormone is an important factor in promoting cell differentiation, children with thyroid hormone deficiency may have low intelligence (due to incomplete differentiation of brain cells) and a silly face, in addition to being short and having underdeveloped sexual organs. The condition is even more serious if the deficiency in thyroid hormone secretion occurs during the fetal period when the nerve cells in the brain are rapidly differentiating. Therefore, in recent years, the routine screening method of blood thyroid hormone measurement has been used for newborns abroad in order to obtain good results in early diagnosis and treatment. Deficiencies in pituitary gonadotropic hormone secretion are also common with adverse effects on growth. In girls, this can manifest as ovarian hypoplasia and lack of secondary sexual characteristics, although intelligence is mostly normal. These girls still have very low levels of gonadotrophins in their urine at puberty, while boys cause secondary onset of functional testicular hypogonadism. These boys have delayed development of the reproductive organs and secondary characteristics, a baby-shaped penis, scant pubic hair, axillary hair, and no beard. As a result of insufficient testosterone secretion, the affected children have weak muscles, narrow chest and shoulders, and significantly delayed epiphyseal healing, while long bones continue to grow, resulting in limbs that are longer than normal and exhibit the characteristic thin and tall height.