What causes growth problems?

The cause of a growth problem depends on the type of growth disorder in question. Some growth problems are genetic, while others may be caused by hormonal disorders or poor absorption of food. Causes for growth problems usually fall into the following categories:

• Familial short stature. Familial short stature is a tendency to follow the family's inherited short stature (shortness).

• Constitutional growth delay with delayed adolescence or delayed maturation. A child who tends to be shorter than average and who enters puberty later than average — but is growing at a normal rate — may ave a growth delay. 

• Illnesses that affect the whole body (also called systemic diseases). Constant malnutrition, digestive tract diseases, kidney disease, heart disease, lung disease, diabetes, and severe stress can cause growth problems.

• Endocrine (hormone) diseases. Adequate production of the thyroid hormone is necessary for normal bone growth. Cushing's syndrome, a rare condition, can be caused by a myriad of abnormalities that result in hypersecretion of corticosteroids by the adrenal gland. Growth hormone deficiency involves a problem with the pituitary gland (small gland at the base of the brain). The pituitary gland secretes several hormones, including growth hormone.

• Congenital (present at birth) problems in the tissues where growth occurs. With a condition called intrauterine growth restriction (IUGR), slow growth within the uterus occurs during a pregnancy. This can be caused by many factors, including smoking during pregnancy. The baby is born smaller in weight and length than normal, although proportionate to his/her short stature.

Having too many or too few chromosomes can result in health problems, including problems with growth. A common chromosome abnormality that results from too few chromosomes is the following:

• Turner syndrome is a genetic disorder seen in girls that causes them to be shorter than others and fail to develop during puberty. The severity of these problems varies among affected individuals. Other health problems may also be present involving the heart or renal system (kidneys, etc.). Many conditions can be managed or corrected by medical treatment. Turner syndrome occurs in one in 2,500 females born. The features of Turner syndrome result from having a missing X chromosome in each of the body's cells.

There are different bone diseases that affect height and growth, many of which are genetic. The most common is achondroplasia, a type of dwarfism in which the child's arms and legs are short in proportion to his or her body length. Further, the head is often large and the trunk is normal size.

• Tall stature. Some girls may have an abnormally tall stature for their age if their parents are tall. In addition, a growth disorder called precocious puberty is characterized by an early onset of adolescence in which a child is tall for his or her age initially, but, due to rapid bone maturity, growth stops at an early age and they may be short as adults. There are a few genetic conditions that result in tall stature with other health problems also present. There are several growth disorders that are idiopathic with no known cause for the growth problem.

What are the symptoms of growth problems?

Some growth problems may be immediately diagnosed at birth, because the infant may be abnormally small for his or her age. However, many growth problems are noticed much later, when the child appears smaller than his or her classmates, or when growth appears to be insignificant over a period of a year.

The primary symptom that may indicate a growth problem is when a child grows less than two inches a year after his or her third birthday. Symptoms of growth problems may resemble other problems or medical conditions. Always consult your child's doctor for a diagnosis.

How is a growth problem diagnosed?

Diagnosis of a growth problem must be made by your child's doctor. The method used for diagnosis will depend on the type of growth disorder presented.

At The Children's Hospital of Philadelphia, children with growth problems are examined by gastroenterologists, nutritionists and geneticists who work with the Division of Gastroenterology (GI), Hepatology and Nutrition.

Your child's clinical team will complete a medical history and physical examination of your child. Diagnostic tests may include:

• Observing your child's health and growth over several months
• Blood tests (to rule out hormone, chromosomal, or other disorders associated with growth failure)
• X-ray of the bones (electromagnetic energy used to produce images of bones and internal organs on film to determine maturity and growth potential of bones)
• Examining the functions of the pituitary gland, which produces and secretes growth hormone and other hormones

How are growth problems treated?

Specific treatment for growth problems will be determined by your child's doctor or care team. Plans will be based on:

• Your child's current health status and health history
• Severity of the problem
• Your child's ability to deal with medical procedures and take prescribed medicines
• Your beliefs and desires regarding treatment

Treatment of growth problems will depend on the type of growth disorder presented. If a medical condition causes the growth problem, treatment of that condition may alleviate the growth problem.