I. What is short stature?
Children from 2 years old to prepubertal age can calculate normal height by the formula: number of years x 7 + 75 (cm). A child who is 2 standard deviations below normal height (about 6-7% of normal height for the corresponding age) or 3 percentile below the average height of children of the same age and gender (in common parlance, a hundred children of the same age and gender are lined up according to their size, and the last 3 are short) is called short stature. The normal height of each age group and the diagnostic criteria for dwarfism can be found in the “Table of Normal Height Standards for Children and Adolescents of All Ages”.
What are the causes of short stature?
Endocrine, disease, genetic and nutritional factors can cause short stature, among which the more common causes are growth hormone deficiency, idiopathic dwarfism, precocious puberty and genetic metabolic diseases. Of course, exercise, sleep and mental factors are also related to growth.
What should I do if I find out that I am short in stature?
First of all, you should go to a regular hospital for endocrine examination of children to identify the cause and do targeted treatment. There are more than 300 kinds of diseases known to be related to short stature, and it is undoubtedly terrible to take medicine without distinguishing the cause. Some height increasing drugs on the market contain sex hormones, which are suspected of “pulling out the seedlings to help them grow” and can promote the early fusion of epiphysis (bone growth line), leading to premature stoppage of bone growth and eventual decrease in height.
What tests should be done for short stature?
First of all, a left hand X-ray of bone age should be taken to understand the size of bone age and to make an annual height prediction. Usually, when the bones are developing normally, the bone age and the age are approximately equal. If the difference between bone age and age is too large or the predicted height is too low, the cause should be actively sought. Bone age greater than age (e.g., 10 years for an 8-year-old child) is most commonly associated with precocious puberty and hyperthyroidism. If the bone age is younger than age (e.g., 6 years old in an 8-year-old child), it is most likely due to growth hormone deficiency and delayed sexual development. If the epiphysis is closed, no more growth is possible. For children who need to apply growth hormone treatment, it is usually necessary to check magnetic resonance imaging (MRI) of the head, liver and kidney function, blood glucose, blood routine and insulin-like growth factors (IGF-1 and IGFBP-3), etc.
V. How effective is the current treatment for short stature?
If it is due to thyroxine deficiency, only oral thyroxine tablets are needed, which can increase the height of children at a young age by an average of 8-16 cm per year and improve their intelligence; if it is due to growth hormone deficiency or lack of growth hormone activity, the effect of growth hormone injection is also quite good, which can increase the height by an average of 8-14 cm per year; for precocious puberty, the application of gonadotropin-releasing hormone analog (GnRHa) is safe and effective, which can inhibit sexual maturation. is safe and effective, and can inhibit sexual maturation and improve lifelong height. Meanwhile, since height growth is mainly related to growth hormone, there are many etiologies of short stature that are caused by reduced secretion of growth hormone, including some patients with familial short stature, which are also indications for growth hormone therapy.
When is the most appropriate time to treat children with short stature?
The earlier the treatment, the better the effect, especially for children with hypothyroidism, which can affect intellectual development if not treated in time. Some parents think that children with short stature are “late growing” or caused by malnutrition, so it is easy to delay the best time for treatment. In China, the standard of living has improved significantly in the past 20 to 30 years, while food safety has declined, environmental pollution, health care products have proliferated, and various kinds of bad information have been disseminated, children’s development is significantly earlier than the previous generation. Dwarf children often eat smaller amounts due to their slow growth and low physiological needs. For early detection, in addition to comparing height with children of the same age, you should usually pay attention to the growth rate of your child, which is less than 4 to 5 cm per year from age 3 to puberty and less than 5. 5 to 6 cm per year during puberty, which is considered as growth retardation, and you should go to the hospital for examination and consultation with a pediatric endocrinologist. For example, the growth rate of height of girls begins to slow down after the age of 12, and decreases sharply to 1~2 cm per year after the age of 14. The average length of women after menarche is 5~7 cm. Once puberty is over, the epiphysis closes and no more growth is possible. Of course, premature use is also inappropriate, as normal human growth is regulated differently at different stages of growth. 1 week of age before the continuation of intrauterine growth regulation to metabolic axis regulation, 1 week of age after the gradual transition to growth hormone regulation (thus growth hormone deficient people are often not short before 1 week of age), 2 weeks of age and above is basically growth hormone regulation, very few need to be completely regulated by growth hormone until about 3 weeks of age. Therefore, although some people advocate that the application can be started after 2 years old, most people think it is better to use it after 4 years old.
Is growth hormone injection safe?
Unlike sex hormones and adrenocorticotropic hormones, growth hormone is synthesized by the pituitary gland and is released at regular intervals. At present, synthetic growth hormone is completely consistent with the human body’s own growth hormone, and when choosing the timing of injection, it matches the human body’s physiological process as much as possible, and almost does not affect the human endocrine system. Growth hormone has been used abroad for more than 50 years to increase children’s height. Genetically recombinant human growth hormone (rhGH) is the only safe and effective drug approved by the U.S. Food and Drug Administration (FDA), which is the most stringent agency in international drug review, and can increase the height of short children by 8 to 14 cm per year. The European Society for Pediatric Endocrinology (ESPE) summarized the results of decades of treatment trials and officially announced in 1993 that “rhGH has surprisingly good efficacy and safety when applied to conventional treatment”.
Is growth hormone available for normal people who are not satisfied with their height?
On July 25, 2003, the FDA relaxed the scope of use of synthetic human growth hormone, allowing children who are abnormally short but healthy to increase their height through growth hormone injections. Since such patients are generally older at the time of consultation, the improvement in final height is often limited, with most only increasing by 3-5 cm. Moreover, growth hormone treatment is still expensive and requires subcutaneous injections to be effective, which can be painful. Foreign studies have shown that “70% of human height is determined by genetic factors and 30% by acquired factors”. For normal people to grow taller, adequate sleep, aerobic exercise (moderate intensity, regular, continuous, not less than 20 minutes each time, outdoors as much as possible), and a balanced diet are important, and treatment is not encouraged.
9. Is there any treatment for familial dwarfism?
The height of parents is closely related to the height of children, and the calculation of hereditary height is as follows: boy = 45.99+0.78×(father’s height+mother’s height)÷2±5.29cm; girl = 37.85+0.75×(father’s height+mother’s height)÷2±5.29cm. huge”. This is mainly related to nutrition, exercise, sleep, chronic diseases, and even mental factors, and it is possible to reach the high limit with proper attention. Of course, familial dwarfism can be classified as idiopathic dwarfism. In most cases, as long as the epiphysis is not closed, and after detailed examination and exclusion of factors that are not suitable for treatment, the lifelong height can be improved to some extent by appropriate treatment. At the same time, since neither parent has undergone any examination and treatment for dwarfism in the past, it does not mean that there are certainly no diseases affecting height in the family. Some diseases can now be examined and effectively treated, and if the child has the same disease, it is entirely possible to achieve a more desirable lifelong height through examination and treatment. If your child is found to be short, you should seek proper examination and consultation with a pediatric endocrinologist when applied.
X. Does growth hormone promote bone age growth?
No.