1. Should I have my child examined if he or she is short?
A: Evaluating a child’s height development involves multiple factors and more complex statistical processing. The common evaluation methods are percentile method, deviation method and index method. The so-called percentile method of height evaluation is to take out 100 boys or girls of a certain age group at random and arrange them according to the number of centimeters of height from small to large, with the small percentile value being low and the large percentile value being high, to find out the value of a certain percentile (with P as the code), which is often divided into the 3rd, 10th, 25th, 50, 75, 90 and 97th percentile. p3 represents the 3rd percentile value and p97 represents the 97th percentile value. P3 represents the 3rd percentile value and P97 represents the 97th percentile value. Medical science classifies human growth and development into five classes based on the percentile method: upper class is >P97, upper middle class is >P75, middle class is P25-P75, and lower middle class is P3.
It is generally accepted that children whose height is within the 10th-90th percentile range should be considered normal. Children who are not within the above range, or children aged 4-12 years who grow less than 5 cm per year, are considered abnormal and should be promptly consulted and treated at a hospital specialty clinic (pediatric endocrinology) for further evaluation.
2. What tests should be done for children who are short and what preparations should be made before the examination?
A: There are many causes of short stature, and in order to treat it, we must find out the cause and make a correct diagnosis, and then consider how to treat it. In order to find out the cause of the disease, we must first investigate through medical history, physical and laboratory examinations, and based on detailed information and laboratory results, we will make a comprehensive analysis to determine the cause of the child’s dwarfism and finally determine the principle of treatment.
Parents of children with short stature should provide the following information when they visit the hospital: 1. the mother’s pregnancy, the baby’s condition at birth, whether the birth was difficult, asphyxia, and what kind of delivery method was used, the height and weight at birth, etc. 2. the annual height growth rate, and the shoes should be removed for the measurement. 3. the parents’ height and youth development, and whether there are short stature in the family. 4. the intellectual development, the presence of chronic hepatitis, kidney disease and asthma. 5. 5. the use of drugs that affect growth and development, such as prednisone (prednisone), dexamethasone and other glucocorticoids, etc.
When the child arrives at the hospital, routine blood and urine tests, liver and kidney function tests and thyroid hormone level tests are performed, and karyotype analysis is done for girls. Next, x-rays of the left wrist and metacarpal fingers are needed to understand the age of the bones and to determine the growth of the bones, the degree of epiphyseal closure and the growth potential of the child. If necessary, blood will be drawn to test the levels of growth hormone and growth factors. In addition, if short stature is considered to be growth hormone deficiency, a growth hormone stimulation test is required for diagnosis. MRI of the skull is performed in all children with short stature to rule out the possibility of congenital developmental abnormalities or tumors.
Please note: Some tests may require fasting, so please be careful to avoid eating before the test. Some tests may not produce results on the same day, so please consult your treating doctor for details.
3. What is the approximate cost of a comprehensive checkup for children with short stature? If growth hormone is used, how is the cost calculated?
A: Short stature in children belongs to the category of pediatric endocrine diseases. Routine examinations include: bone age, blood count, blood glucose, nail function, growth hormone, urine count, CT, liver function, kidney function and so on. A comprehensive examination in some hospitals in Guangzhou costs about 3,000 yuan, usually more than 2,000 yuan.
The cost of growth hormone treatment depends on the child’s own situation, as the treatment is related to the treatment dose, which in turn is related to the indications and weight, and the treatment cost is relatively high. Generally speaking, if a child is diagnosed with short stature, the earlier the treatment is given, the less it will cost.
4. How do I know if growth hormone treatment is effective?
A: The clinical judgment of the effectiveness of growth hormone treatment is that the annual growth rate after treatment increases by more than 2 cm/year compared to that before treatment. Growth hormone can be tried for 3 months, and if it grows by more than 2 cm in 3 months, then it is effective. If the growth is less than 2 centimeters, you need to analyze the factors that affect the effectiveness of the treatment together with your treating doctor.
Some parents often ask why their child has not grown after using growth hormone for a month or two. It is important to remind parents not to enter the misconception that their children will grow taller quickly with the application of growth hormone therapy, because this is unrealistic and not in line with the laws of natural science. From the perspective of children’s growth and development, height growth is a relatively slow process, and it is impossible to achieve “instant results” after using the medicine. The effectiveness of clinical growth hormone treatment for children with short stature is judged by the following criteria: an increase in the annual growth rate of the child by more than 2 cm compared to that before treatment is considered effective. Generally, 3 months of growth hormone treatment is a course of observation, and relatively obvious treatment effects can be seen in 3 months. It is normal for a child to grow more than 2 cm in 3 months of treatment. It has been clinically proven that growth hormone treatment for children with short stature can effectively improve the growth rate of the child, thus improving his or her final height.
5. What is the duration of growth hormone treatment?
A: The duration of growth hormone therapy should be determined according to the indications of the child, the difference in height compared to the normal standard, the bone age, and the family’s economic status, etc. Generally, the treatment should last at least 3-4 months to observe the efficacy. It is important to listen to the advice of the attending physician and follow the medical advice for treatment.
6. What kind of review should be done after growth hormone treatment? Is it necessary to redo the growth hormone drug stimulation test? Are there any cases in which normal growth hormone secretion was restored after treatment?
A: After growth hormone treatment, height should be counted every 3 months, and bone age can be reviewed every 6 months. Generally, thyroid function and blood sugar need to be checked, and MRI is not necessary if there is no problem. Monitoring of IGF-1 and IGF-BP3 should be considered 1-2 months after medication, depending on the advice of the primary care physician. There is no need to redo the growth hormone stimulation test. Complete growth hormone deficiency is rarely self-recovering, except for partial deficiency that is critical for normal growth and may resolve with puberty.
7. Can I use growth hormone to treat short stature that is not caused by growth hormone deficiency?
A: There are many diseases that cause short stature in children, including idiopathic short stature (ISS) and intrauterine growth retardation (IUGR), which are often not caused by growth hormone deficiency, but are also indications for growth hormone as prescribed by the US FDA. Precocious puberty can lead to suboptimal lifelong height in children, and the combination of growth hormone with treatment of precocious puberty can also improve lifelong height. Among all indications, growth hormone deficiency is relatively the best treatment, and some children can have their annual growth rate increased up to 12 cm/year.
8. My child has already started the medication, how can I use it for the best effect? If the family has financial problems, is it okay to stop using it for a while?
A: In addition to daily injections (short-acting growth hormone) and weekly injections (long-acting growth hormone), proper exercise and sleep should be added to ensure the effectiveness of the treatment. In addition, you should go to the hospital for regular review and consider increasing the dosage if your child gains weight or is in late adolescence. If there is a family financial problem, you can stop the medication after six months to more than a year of continuous use. However, it is generally not recommended to stop the medication, but to continue the treatment and to ensure a good therapeutic effect with a sufficient amount and a sufficient course of treatment.
9.What is the best age to inject growth hormone for the treatment of children with short stature?
A: The earlier the treatment, the better. The best time for treatment is before puberty. If the diagnosis is clear, treatment can be started after the child is 4 years old.
10.When is it necessary to stop using growth hormone treatment?
A: The criteria for stopping growth hormone treatment are: 1. epiphyseal closure; 2. significant side effects to growth hormone treatment (e.g. hyperglycemia, abnormal liver function); 3. the child has a tumor; 4. the height goal expected by parents is reached; 5. the growth rate decreases after treatment due to antibodies and other reasons, and the purpose of height improvement cannot be achieved. Due to the different expectations of each parent and the different economic level of the family, please refer to the above reasons whether to stop the drug or not. From the doctor’s point of view, the child should be supported to achieve normal height, and the pre-developmental height level is especially important. The older the child is, the more the treatment cost will increase due to the change of weight. Internationally, replacement therapy for adult GHD has already started. The goal of replacement therapy in childhood is to improve lifelong height, and strictly speaking growth hormone replacement should be a lifelong treatment for individuals with growth hormone deficiency, only the dose will vary with age.