How to treat short stature in children

       Short stature is the most common endocrine disorder in children’s growth and development today, and is of great concern to children themselves, parents, teachers, and society. However, despite this, the consultation, diagnosis and treatment of short stature in children is always too late. Often, patients with dwarfism who are over 25 years old come to the doctor, and although their height can increase with treatment, it is impossible to reach the final average height of adults. Therefore, early detection, early diagnosis and early treatment of dwarfism are very important.  There are several categories of causes of short stature in children, mainly growth hormone deficiency, and non-growth hormone deficiency. Among the non-growth hormone deficiency diseases, there are familial short stature (genetic short stature of mothers and fathers), delayed physical puberty (lack of puberty development or delayed puberty development leading to lifelong adult height failure), nutritional deficiency growth disorder, congenital ovarian hypoplasia (short stature due to chromosomal defects in girls), and chondrodysplasia, which can cause growth disorders. All of these conditions are indications for growth hormone treatment as confirmed by the FDA.  The earlier the treatment, the better the outcome. The younger the age at which proper treatment begins, the better the outcome. Studies have shown that children with dwarfism caused by growth hormone deficiency can achieve nearly normal and rapid height growth with growth hormone treatment before the age of 3, and their final height is almost indistinguishable from that of a normal person. However, very few patients can start treatment at the age of 3 to 4 years old, and most patients come to the clinic only after puberty because they encounter setbacks in school, job assignment, military, marriage, etc. At this time, the treatment is effective, but far less effective than the treatment when they are young.  The treatment of short stature is mainly selected according to different causes. The goals of treatment are: first, to maintain normal growth rate, second, to win rapid growth in adolescence, and third, to achieve final adult height. Growth hormone injections are the main method of treatment for short stature. The growth hormone currently used in clinical practice is genetically recombinant synthetic growth hormone, which is identical in structure and function to the growth hormone secreted by the human pituitary gland. However, the treatment of short stature with growth hormone is not a panacea. The best treatment is for complete or partial growth hormone deficiency, and those that may be effective are idiopathic short stature, Turner syndrome, familial short stature, etc.  The medical community has been divided on whether growth hormone can be used to treat dwarfism, which is not a growth hormone deficiency. In recent years, several large clinical studies have found that growth hormone injections can increase the height of children who are short in stature but healthy and not deficient in growth hormone by 3.8 to 7 cm by the time they reach adulthood. However, it is important to emphasize that growth hormone medication is intended for boys who are expected to be less than 160 cm tall in adulthood and girls who are less than 147 cm tall. During the period of growth hormone treatment, the efficacy of the treatment needs to be followed up continuously every 3 months. Most people who are treated with growth hormone have an annual increase in height of 7 to 12 cm. If the expected growth does not occur, the reasons must be carefully analyzed, such as: intermittent treatment, poor preparation or injection technique, occurrence of hypothyroidism with systemic chronic diseases, epiphysis already closed, presence of excessive anti-growth hormone antibodies in the blood, short stature not due to growth hormone deficiency, untimely nutritional The number of patients with short stature was not increased in time. If these factors are found during the follow-up, they need to be addressed in a timely manner. Even if the child is growing well, thyroid function and bone age should be checked once a year. The current rate of abnormal dwarfism in children is about 1.2%, and about hundreds of thousands of children between 7 and 15 years of age need active treatment.  In conclusion, in general, those with taller parents, more adequate nutrition and more diligent physical activity have taller stature. However, all of these influences need to be based on physiological amounts of growth hormone. When it is found that height growth is less than 7 cm/year in infancy under 3 years old, less than 4 cm/year in preschool and school age (3 years old – pre-pubertal), and less than 5.5-6.5 cm/year in puberty,, growth hormone and epiphysis examination should be done, and if a deficiency is found, the earlier supplemental treatment should be done, the better, and supplemental growth hormone treatment after 18 years old is three times less effective. May parents all over the world create good growth conditions for their children. Short stature is valuable for early diagnosis and treatment.