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WHAT IS GROWTH RETARDATION?

 

Growth retardation is a slower rate of growth than expected for a child's age. It is a term generally applied to children over a year old.

 

Many healthy children are small for their age, but eventually catch up and become normal-sized adults.

 

Often there is a familial tendency to being a 'late developer', so you need to compare your child's height with your own at a similar age - your parents may be able to help you.

 

As a rough guide, birth length doubles by approximately four years of age and trebles by approximately 1 3 years.

 

Your health visitor will have plotted your child's weight, length and head circumference in her early years, on a standard growth chart (found in your child's health record book). The chart shows printed growth curves, known as centiles. In normal growth, a child's height is plotted between the first and last centile. There is cause for concern if the rate of growth does not follow the curve of the chart.

 

Causes of growth retardation

 

There are many different possible causes of growth retardation. They include:

 

Genetic: your child may have inherited slow growth, eventually achieving a normal, average adult height; or she may have inherited a family tendency to short stature, and will have a short final adult height. Genetic disorders include achondroplasia, one of the commonest forms of dwarfism. Another is precocious (early) puberty, which can result in short stature because puberty is closely associated with the maturation of the long bones and the cessation of growth

 

Chromosomal disorders:  these include Down's syndrome and Turner's syndrome

 

Endocrine (hormonal) disorders:  these include growth hormone and thyroid hormone deficiencies. Growth hormone deficiencies more common in boys than girls. Congenital thyroid. hormone deficiency is tested a week after the birth.  If detected, this can be treated successfully.

 

Chronic medical disorders: particularly disorders affecting the bowel and therefore absorption of nutrients, e.g. coeliac disease. Other chronic disorders adversely affecting growth include kidney and heart disorders, diabetes, thalassaemia and cystic fibrosis. A child who suffers repeated infectious illnesses, with loss of appetite, may also suffer growth retardation.

 

Social factors: poor nutrition with a consistently inadequate diet, or emotional neglect or abuse, will sometimes result in growth retardation.

 

Premature and small babies

 

At birth the weight of some babies falls below the 10th centile on the standard growth charts.

 

• Babies can fall into this category whether born prematurely or at full term.
• Babies who are small may have suffered intrauterine growth retardation, which has many causes, making it difficult to assess expected growth outcome. Possible causes include placental insufficiency, poor maternal nutrition and chromosomal abnormalities.
• Premature babies are often an appropriate weight for their gestational age. Most premature babies catch up in growth by the age of two years, but some do not, and it is very difficult to predict which ones will. 
• If your baby was premature, you must remember to correct his age according to his due date when assessing his growth. 

Helping your child

 

Children who are small for their age are often taken to be younger than they are, and treated as such. As a parent, there are ways you can help.

 

Encourage self-confidence: encouraging your child to develop self-confidence and to defend himself can help. After all, character and personality matter far more than height. This is particularly important at school, where bullying can be a problem. Any unkind comments or hint of bullying should be addressed immediately with your child's school.

 

Provide reassurance: delayed onset of puberty is associated with growth retardation, and this can cause embarrassment to adolescents, especially boys. Reassure your child that he will catch up and that everyone develops at different rates

 

Discuss your worries: inherited slow growth or short stature do not make your child more likely to have delayed intellectual development, but if you feel your child is not attaining the developmental milestones, do discuss this with your doctor or health visitor

 

Seek specialist help: children with some chromosomal abnormalities, such as Down's syndrome, may need additional stimulation in the early years to encourage their development. In some areas special groups are set up for this purpose, which your doctor or health visitor should be able to arrange for you. These children may be able to attend a mainstream primary school in the early years, but may then need to transfer to a special needs unit.

 

Provide support: remember that whatever the cause or extent of your child's growth retardation, your reassurance and support are vital.

 

Possible treatments

 

If you are concerned about your child's height, you should consult your GP or health visitor. There is a series of tests and investigations that can be done to monitor any problems.

 

• Your health visitor may take measurements over a period of 12 months. She will plot them on a special growth chart. Your child's health record book, which includes the original growth charts, should be taken into consideration, too. 
• Plotting the measurements will show whether your child is below average or of normal height and weight for his age. If your child's rate of growth is normal, the plotted curve will follow the curve of one of the printed centile lines on the chart. If the plotted growth curve falls away from the printed curves, your child's rate of growth is slowing down. If it falls away across more than two centile lines, the cause usually needs investigating, and your child may be referred to a paediatrician or to a specialist growth clinic. 
• Investigations may include an X-ray of your child's hand and wrist (or feet and legs if your child is under 18 months) to assess his 'bone age' - an indication of the maturation of the bones. 
• If your child's bone age is significantly less than his chronological age, there is more growth potential in the bones and a possibility that he may eventually reach a normal adult height. However, if your child's bone age is very similar to his chronological age, he is more likely to remain short. 
• Blood tests may also be carried out to check for any deficiencies or abnormalities that may cause or contribute to growth retardation. 
• Growth hormone deficiency can be demonstrated using a series of blood tests and exercise tests. Either growth hormone itself, or growth hormone releasing factor, may be used to treat a deficiency, and with early recognition, the treatment can often be very successful. It does, however require daily injections up until adulthood. 
• If the underlying cause of growth retardation is nutritional, you will be given dietary advice and possibly special supplements to supply extra calories and nutrients. 

For  More  Information:  Please  consult  your  physician  on  your  next  visit.