The child is not growing, why don’t you see a doctor? Parents will regret it forever

If your child doesn't grow taller, should you just wait or take some measures? The reporter asked colleagues and friends around him, and most of them answered "wait" or "let the child eat more." Things are not that simple!

Recently, our reporter interviewed Professor Wu Xueyan, head of the Pituitary-Gonad Research Center of the Department of Endocrinology at Peking Union Medical College Hospital. Wu Xueyan has been engaged in clinical and basic research in gonadal reproductive endocrinology for many years. He has in-depth research on children's growth and development, sexual differentiation and male reproductive endocrinology theory, and has rich clinical experience in the diagnosis and treatment of abnormal puberty.

When is a child's height considered abnormal? Wu Xueyan said that this should be compared with people of the same race, generation and gender. A height that is more than two standard deviations or three percentiles below the average height of the normal population can be considered short. To put it another way, after the age of 2, a child's height will increase by 5 to 6 cm each year. If a child is more than 5 to 6 cm shorter than the average height of his peers, it means that he is one year behind other children in height growth. This should cause concern and it is best to go to a professional clinic for examination. If treatment is needed after examination, it should be given in a timely manner. At the same time, Wu Xueyan also pointed out that abnormal height may also be an important manifestation of certain diseases. "Waiting" may delay the child's final height or delay the treatment of some diseases.

Growth hormone is the key to height growth

Height is affected by many factors, such as genetics, nutrition, and development. In particular, it is closely related to the level of growth hormone and the body's sensitivity to growth hormone. Wu Xueyan introduced that growth hormone is a protein hormone synthesized and secreted by the pituitary gland. As the name suggests, it is a hormone that can promote height growth. The growth of children's height depends first on the normal secretion of growth hormone, which is the basic hormone for height growth. Before puberty, growth hormone is only secreted when children are soundly asleep every day, so ensuring children's sleep can ensure the secretion of growth hormone. If some diseases affect the secretion of growth hormone, it will inevitably cause children to not grow taller. For example, if there is a difficult labor at birth, the pituitary gland will be stretched and damaged, and the child will be prone to growth hormone resistance.

On the other hand, Wu Xueyan pointed out that even if the secretion of growth hormone is normal, if the human body does not respond normally to growth hormone, it will affect the growth of height. That is to say, even if a child is not deficient in growth hormone, his body cannot utilize the growth hormone well and he will grow slowly. This condition is clinically called growth hormone insensitivity or growth hormone resistance. It is the cause of most children with "unexplained short stature" in clinical practice, also known as idiopathic short stature.

To sum up, anything that directly or indirectly affects the secretion of growth hormone, or interferes with the action of growth hormone, can affect growth.

Precocious or delayed puberty can affect height

Wu Xueyan introduced that height growth is also closely related to development. During puberty, height growth accelerates. This is because the increase in sex hormone secretion during puberty itself will promote height growth. At the same time, sex hormones can promote the secretion of growth hormone, further promoting growth. Children will suddenly "grow taller" during this period. However, sex hormones accelerate the closure of the epiphysis. Once the epiphysis closes, the height can no longer grow, and thus the lifelong height is reached, which is the maximum height in life.

When girls develop secondary sexual characteristics before the age of 8 or boys before the age of 9, it is called precocious puberty; if neither boys nor girls have developed by the age of 14, it is called delayed puberty. Wu Xueyan pointed out that whether it is precocious puberty or delayed puberty, it will affect the child's final height. In particular, precocious puberty often leads to a significant decrease in lifetime height, which should arouse the great concern of children's parents.

Children with precocious puberty will be taller than their peers in the short term, but their ultimate height will still be lower than the average for their peers. Why is this happening? Wu Xueyan said that because height growth during puberty only accounts for about 20% of the total height growth, during this period, boys will grow about 30cm and girls will grow about 25cm (children with precocious puberty generally do not grow to this level during their sexual development period). About 80% of height grows before puberty. This 80% can be regarded as the "basic" height, which should be above 140cm~145cm. If the "basic" height has not grown enough, puberty will come early. Although the baby will grow some height in a short period of time, the epiphysis will close quickly and will no longer grow. If sexual development occurs one year earlier, such a child will be 5 to 6 cm shorter than other children. If it occurs two years earlier, it will be 10 to 12 cm shorter. This will inevitably affect the final height.

Wu Xueyan introduced that there are many reasons for precocious puberty. Those for which no cause can be found are called idiopathic precocious puberty. Others are caused by intracranial tumors, craniocerebral trauma, intracranial infection, or long-term use of certain drugs. These factors can destroy the mechanism that inhibits sexual development, resulting in precocious puberty. Precocious puberty is also related to nutritional status and genetics. If parents develop early, their children are likely to develop early as well. He also specifically reminded that if there are sex hormones in the living environment and children are exposed to them for a long time, it will also lead to precocious puberty. If there is a lot of contact, obvious secondary sexual characteristics will appear quickly, which is relatively easy to detect. However, long-term, small-scale contact may have hidden effects. For example, although there will be no obvious secondary sexual characteristics, the bone age will increase "overage", causing premature sexual development and leading to premature closure of the epiphysis.

Children with delayed sexual development may also be shorter than their peers. Wu Xueyan pointed out that when other children reach puberty, their height begins to "accelerate", but children with delayed development cannot start the "acceleration program", which can also cause their height to temporarily fail to keep up with the average.

Active treatment can improve

In addition to sex hormones and growth hormones, thyroid hormones also have a very important influence on height. Congenital or childhood deficiency of thyroid hormones can cause cretinism. Patients with cretinism have stagnant bone growth, short stature, and an abnormal length ratio between the upper and lower body. Wu Xueyan pointed out that some other systemic diseases such as anemia, asthma, snoring, parasitic diseases, tuberculosis, etc. will also affect growth. Because anemia, asthma, and snoring will affect the body's oxygen supply, parasitic diseases and tuberculosis will consume the body's nutrients, these will affect children's growth and development, thereby affecting their height growth.

Wu Xueyan reminded that if parents find that their children are 5 to 6 cm shorter than other children of the same age, or have precocious or delayed puberty, they should take their children to a regular professional clinic for consultation and examination in time. After finding the cause, appropriate treatment can be carried out under the guidance of a doctor.

If growth and development problems are caused by systemic diseases, such as anemia, then the anemia must be actively corrected. If you have pulmonary tuberculosis, you need to undergo regular anti-tuberculosis treatment, etc. Once these causes are eliminated, the child's growth can return to normal track and catch-up growth may occur. Wu Xueyan said that by paying attention to height, systemic diseases of children can be discovered, which are complementary.

If it is a growth hormone deficiency, Wu Xueyan pointed out that growth hormone supplementation treatment should be carried out. Many parents get scared when they hear the word "hormone". Wu Xueyan said that growth hormone is a hormone secreted and exists in the human body. The growth hormone used in clinical practice has basically the same structure as the growth hormone secreted by the human body. Depending on the deficiency situation, it is safe to use under the guidance of a professional physician. However, growth hormone cannot be abused and should be used when the epiphysis has not closed; and some prohibited situations should be excluded.

Regarding cases of early or late sexual development, Wu Xueyan said that the first thing to do is to treat the cause, that is, to treat the cause of the abnormal sexual development. For example, intracranial tumors can be treated through surgery and other methods. Secondly, depending on the situation, children who enter sexual development prematurely or delayed should be actively treated with medication to inhibit or awaken sexual development. At the same time, add an appropriate amount of growth hormone to accelerate its growth on the original basis or maintain its original growth rate. All of these can be achieved medically at present.

Wu Xueyan reminds that parents should develop the habit of writing a growth diary for their children. If a child grows too slowly or too fast (possibly premature development), it should be taken seriously.