Growth Failure in Children
Facts on Growth Failure in Children
Growth failure is a term used to describe a growth rate that is below the appropriate growth velocity (speed) for age. The term growth delay may refer to a situation in which a child is short but appears to be able to grow longer than children usually do, and thus, may not end up short as an adult. Dwarfism is a term that has often been used to describe extreme short stature; however, the term is unflattering and its use is often avoided. Growth hormone deficiency is sometimes called pituitary dwarfism.
Short stature may be a normal expression of a person's genetic potential and, therefore, the growth rate is normal. Short stature may also be a result of a condition that causes growth failure and a growth rate that is slower than normal.
A child is considered to be short if he or she has a height below the 3rd or 5th percentile on a growth chart. A low percentage of all children are considered to be short. However, many of these children have normal growth velocities. The children who fall into this group include those with familial short stature or constitutional growth delay. Those with familial short stature are born with genes that determine their short height, and they usually have parents who are short. Constitutional growth delay is a term used to describe children who are small for their age but who have a normal growth rate. Of all children with short stature, only a few have a specific treatable medical condition.
The most rapid phase of growth occurs in the mother's uterus. After birth, the growth rate gradually declines over the first several years of life. At birth, the average length of a newborn is 20 inches; at 1 year, the average height is about 30 inches; at 2 years, the average height is about 35 inches; and at 3 years, the average height is about 38 inches. After 3 years and until puberty, linear growth continues at a relatively constant rate of 2 inches per year.
What Causes Growth Failure in Children?
Normal growth is the result of several factors, such as nutrition, genetics, and hormones. The following are possible causes of growth failure.
- Familial short stature: Children with this condition have parents with short stature. They have a normal growth velocity, and bone age is not delayed. They enter puberty at a normal time and often complete growth with a short adult height.
- Constitutional growth delay: Also called delayed puberty, children with constitutional growth delay have a normal birth weight, and their growth slows usually during the first year of life. From about age 3 to puberty, these children have an adequate growth velocity. Bone age is usually delayed, and puberty is late. Late puberty allows for more prepubertal growth, usually resulting in a normal adult height. Usually, children with constitutional growth delay do not show growth failure but a period of slow growth velocity occurs during the first year of life and just before puberty.
- Malnutrition: Worldwide, malnutrition is probably the most common cause of growth failure and is usually poverty-related. Nutritional deficiencies in developed countries are more often the result of self-restricted diets. Poor weight gain is often more noticeable than short stature.
- Diseases and disorders: Chronic diseases and systemic disorders that involve the nervous, circulatory, or gastrointestinal systems may be a cause of growth failure. Diseases or disorders involving the liver, kidneys, lungs, or connective tissue may also be a cause.
- Psychosocial dwarfism: This is a disorder of short stature or growth failure and/or delayed puberty. This often occurs in association with emotional deprivation and/or child abuse and neglect.
- Syndromes: Growth failure can be a feature of genetic syndromes, such as Turner syndrome and Down syndrome. It can also be a part of other syndromes, such as Noonan syndrome, Russell-Silver syndrome, and Prader-Willi syndrome.
- Endocrine (hormonal): Endocrine causes include thyroid hormone deficiency (hypothyroidism), growth hormone deficiency, or other hormone disorders. Thyroid hormone is necessary for normal growth; in children with hypothyroidism, growth is extremely slow. Children with growth hormone deficiency have normal body proportions, but they may appear younger than their actual age.
- Other: Growth failure may be related to intrauterine growth retardation (a condition in which children weigh less than 5 pounds at full term or who are small for gestational age if born preterm). Bone and cartilage disorders (called chondrodystrophies) may also be a cause of growth failure. Achondroplasia (one of the most common conditions that cause growth failure and short stature) is a genetic disorder of bone and cartilage. People with achondroplasia have a normal-sized trunk, short arms and short legs, and a slightly enlarged head with a prominent forehead. Adults with this condition are typically about 4 feet tall. There are other chondrodystrophies, such as hypochondroplasia, which are similar to achondroplasia but not as severe.
Medically Reviewed by a Doctor on 11/21/2017
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