I. Height measurement It is necessary to measure the height of children with dwarfism every month after treatment, and since the change in height within one month is small, we need to measure it as accurately as possible. Accurate height measurement needs to pay attention to the “four same”: 1. the same time, because after standing or sitting up, the vertebral space of the human spine will be compressed, morning and evening height will be different, the same time measurement is comparable; 2. the same measuring tape; 3. the same measurer to measure the person, different people, the ruler card in the head of the tightness will be different; 4. The same method of standing, children (required to take off shoes, heels, hips, shoulders and head all against the wall, chest, abdomen, waist as straight as possible, eyes level, the head should not be too tilted, otherwise the highest point of the head can not be measured). If you measure at home, you can put a piece of paper on the wall, and draw a line on the paper after each measurement. It is not necessary to draw a specific height for each measurement, but only to distinguish the difference with the previous month. When measuring at home must pay attention to the ruler and the floor level, you need to use a right angle triangle ruler, or use a hard book, one side against the wall, the other side and the floor level. From time to time, parents will respond, “My child grew 1.5-2 centimeters last month, but how come he didn’t grow at all this month?” The main reason is that it is still related to the measurement error. After a longer treatment time, the growth rate of several months can be averaged (Note: usually do not measure height too often, generally once a month, otherwise it is easy to cause psychological pressure to the child, too much psychological pressure is not conducive to growth). II. Review time and items after growth hormone treatment 1. For children treated with growth hormone, after 3 months of treatment, thyroxine (FT3, FT4 and TSH) and fasting blood sugar need to be rechecked. Since most of the treated patients are dwarf patients, the growth rate was too slow in the past and the thyroxine requirement was low. After the growth was significantly accelerated, the thyroxine requirement increased and a few people may cause a relative deficiency of thyroxine. Thyroxine deficiency requires oral levothyroxine tablets for a short period of time, otherwise the efficacy of growth hormone will be compromised. There are also a few people who have slightly high thyroxine due to excessive regulation of thyroxine. At this time, as long as TSH is not low, there is generally no need to deal with it, and continued use of growth hormone will often automatically drop to normal. 2. In addition to thyroxine and blood glucose, bone age and insulin-like growth factor-1 (IGF-1) and insulin-like growth factor binding protein-3 (IGFBP3) should be checked during the review in about six months. The test results may vary greatly from hospital to hospital, and there are some hospitals whose reagents are not necessarily reliable. if the initial diagnosis is made in our hospital, it is recommended to continue to review the test in our hospital. the review of IGF-1 and IGFBP3 is an important indicator of both the safety of medication and the adjustment of growth factor dose. The latest information from abroad shows that if the dose of growth hormone is adjusted according to the IGF results, the treatment effect is significantly better than the traditional fixed dose. 3, treatment 1 year when the review, it is best to also review liver and kidney function, can be done together with blood sugar. Adjustment of growth hormone dose is generally not needed within a short period of time, and weight change of not more than 10% is generally not needed. Adjustment is not only based on growth rate or weight, but also needs to consider different etiologies, the results of growth hormone stimulation test before the first dose, pubertal development, bone age size, especially the results of IGF-1 and IGFBP-3 review, etc. So it is more evident how important regular review is! The applicable dose of growth hormone therapy has a wide range. We generally start with a smaller dose within the normal range for those with smaller bone age and more treatment time, if the smaller dose has better effect, the cost is relatively lower and side effects are less likely to occur, and if the effect is not satisfactory, then consider adjusting the dose. For children with large bone age and limited treatment time, generally start with a medium or large normal dose, because time is limited and slow observation may affect the final treatment effect. Growth hormone discontinuation indicators For those who start treatment at a younger age, they can temporarily stop for a period of time when their height reaches or slightly exceeds the height of their peers (usually requiring treatment for 2~3 years or longer), and then use it again when their height is significantly lower than that of their peers. For those who are older in bone age, due to the limited treatment time, the indicator for stopping the drug is to stop when the monthly growth rate is less than 4mm for three consecutive months, although the treatment may still improve 1 to 2mm per month at this time, but the available time is already very little, there is no substantial significance. However, for those whose height has approached normal adult height during the treatment period, discontinuation of the drug can also be considered, but a detailed assessment is needed before discontinuing the drug to see if the treatment objective can be achieved.