Normal growth process
There are three periods of child growth: infancy - characterized by the most intensive growth, which depends on the nutrition and hormonal balance of the child's body;
- childhood - from 1 year before puberty. This is the longest period, most determining the final growth of the individual;
- pubertal period - a jump in growth during this period is due to the action of growth hormone, as well as an increase in the production of sex hormones (estrogen in girls and testosterone in boys).
Cease growth
The final growth that a person achieves depends on the size of the long tubular bones, especially the shin and thigh. At the extremities of the long tubular bones of the limbs, there is a cartilaginous growth plate, due to the multiplication of the cells, the bone lengthens. After the puberty age, the cartilaginous plate is replaced with bone tissue, and further growth becomes impossible. However, human bones are capable of remodeling (restoring the structure). That is why they fuse in fractures with the restoration of normal form and strength. In the pubertal period, there is a significant increase in growth, and in girls it occurs earlier than in boys. Some children are much higher or lower than their peers. However, only in rare cases this is due to some disease. The process of growth and development of a child is assessed by three main parameters - the length and mass of the body and the circumference of the head. The indices of the head circumference in infancy are important for evaluating the physical development and growth of the brain. For accurate measurement of growth, special equipment is used. Until the age of two years the length of the child's body is measured in the supine position on a special growth meter. If you suspect any growth disorders, its measurement is more frequent than usual.
Growth tables
The parameters of the child's growth (body length, body weight and head circumference) are recorded in the appropriate standard graphs of growth tables. They clearly demonstrate the process of growth from birth to the age of sixteen. An important indicator of overall physical development, as well as growth of the brain in infancy is the increase in the circumference of the head. The graphs in the growth tables are marked by so-called centiles. The 50th centile means that 50% of the children in the population have the same growth or less; The 75th centile shows that 75% of children in the population have the same growth or lower. The indicators of normal growth in infancy and childhood can vary significantly. When a child's growth does not fall within the boundaries between 97th and 3rd centiles (which define the framework of normal development for a given age), this indicates the presence of any pathological condition causing too low or too high growth. Tallness is rarely a medical problem, and is often even considered an advantage. Nevertheless, children with excessive growth can face social and psychological problems. In addition, tall can be associated with a disease. About tall speak, when the growth of the child goes beyond the 95th centile. In other words, tall children are called children who are above 95% of their peers.
Problems
Tallness is usually a lesser problem for a child than a short stature. Being high for many means having social benefits. However, tall children often look older than their age, and they can be teased by peers. For a girl, excessively high growth can become a psychological problem in the period of puberty.
Causes
There are three main causes of tallness:
- Hereditary
Tallness depends in most cases on the growth and ethnicity of the parents.
- Hormonal
Increased production of metabolic hormones and growth hormones can also lead to tallness.
- Chromosomal Genetic
One of the most common chromosomal pathologies leading to tallness is Kleinfelter syndrome (the patient has three sex chromosomes instead of two - XXY), which occurs at a frequency of 1 in 500 newborn males. Tallness can also be associated with premature puberty.
Treatment
Tallness in itself rarely requires treatment. However, it may be needed to eliminate its cause, for example a pituitary tumor.
Sex hormones
In the absence of an established cause of tallness, treatment is prescribed only in those cases where there is an obvious tendency to ultra-high growth rates. Deciding on the appointment of treatment is not easy - usually in the discussion of this issue involved the child himself, his parents and medical personnel. The most common method of treatment is the appointment of sex hormones (testosterone and estrogen). This therapy is rarely prescribed for girls. High doses of sex hormones slow growth by accelerating the closure of the cartilaginous growth zones of long tubular bones. This method of treatment mimics the natural process occurring in the puberty period, when the growth jump ends. On MRI scans of the brain, a pituitary tumor is visualized (indicated by a circle). It is probably the reason for the excessive growth of this patient. The tumor disrupts the normal hormonal regulation of growth processes.
Gigantism
Robert Pershing Wadlow was the tallest man in world history. At the time of death at the age of 22 in 1940, his growth was more than 2.72 m. At the age of eight he had a height of 1.88 m, and at 13 years old - 2.24 m. The excessive growth of this man was due to the disease - as is assumed to be pituitary gigantism. This is a very rare condition, characterized by the presence of a pituitary tumor that produces growth hormone. Excess production of growth hormone can also be observed in tumors of the hypothalamus. Low growth in children can have different causes. The more a child lags behind in growth from the age norm, the more likely that at the heart of it lies some disease. Excessively low is considered to be growth, the indices of which are below the 3rd centile. This means that 3% of children in the population have the same or less growth in this age group.
Measurement of growth
A single measurement of growth is sufficient to identify a small one, however, repeated measurements more fully reflect the patterns of child growth. For example, you can determine whether the period of normal growth intensity preceded its slowdown, or it was always below normal.
Ratio of height and weight
The discrepancy between height and weight may indicate the cause of the abnormality. For example, if a stunted child has a small weight, even for such a height, one can suspect a lack of nutrition or a chronic illness. Other children may have a relatively large body weight with little growth. This can be the result of hormonal disorders that lead to growth retardation.
• It is important to regularly monitor the weight of children with growth disabilities. An incorrect ratio of height to body weight may indicate the cause.
• In rare cases, short stature may be caused by various diseases, for example achondroplasia - a violation of the growth of long tubular bones. The limbs of such a child are shorter in comparison with the norm. There are six main groups of reasons:
- Hereditary
Low parents almost always have low children; this is the most common reason.
- Constitutional growth retardation
A condition in which growth retardation is an individual feature and is not associated with any disease.
- Lack of nutrition and chronic diseases
With malnutrition (with insufficient or unusual diet), children tend to stunted growth and low body weight. Lack of nutrition in the prenatal period and in childhood, as well as chronic diseases, such as kidney pathology, can lead.
- Emotional deprivation and psychological causes. Children who have been physically or psychologically abused are usually of low stature.
- Hormonal causes
Growth is associated with growth hormone, thyroid hormones and corticosteroids. Their lack leads to a delay in growth.
- Chromosomal abnormalities
Low growth is accompanied by syndromes of Down, Turner and Silver - Russell.
- Proportions of the body
Under dwarfism is understood as an abnormally low growth with a violation of body proportions, which is typical, for example, for achondroplasia (dysplasia of the growth of the cartilaginous plate). Children with achondroplasia have disproportionately short arms and legs, but relatively normal size of the trunk and head. The average height of an adult with achondroplasia is about 1.2 m.
In another form of short stature, all parts of the body are proportionally small. In this case, growth retardation may be associated with hormone deficiency. To confirm the diagnosis of stunting and to identify its cause, regular measurements of height and weight are needed. Helps in diagnosis the definition of bone age according to the radiograph of the brush. It also allows to determine the potential final growth of a patient with a short stature.
Determination of the level of hormones
Determining the level of hormones can help in diagnosing when the cause of stunting is hormone deficiency. The level of some hormones is easier to determine, others - more difficult. For example, the content of thyroxine in the blood can be measured directly. Determination of growth hormone is a much more laborious process, since its level varies depending on the time of day, and therefore, a series of analyzes of the sprinkling is necessary to identify its insufficiency. More effective diagnostic methods have been developed, for example, samples with stimulation of growth hormone secretion. Such tests, including stimulation with insulin, should be carried out under the supervision of a doctor, as they carry a potential risk to the child. Most often, short stature does not require treatment, since in the overwhelming majority of cases it is due to hereditary causes and has no pathological basis. Therapy is prescribed with obvious insufficiency of growth hormone. The deficiency of growth hormone can be compensated by the appointment of a drug of human growth hormone. It is injected daily. During the first year of treatment, the growth increment can be up to 10 cm, and for each subsequent year, 5-7.5 cm.
A growth hormone
Previously, growth hormone could only be obtained from the pituitary gland of a deceased person. At present, with the help of biotechnology, industrial production of its preparations is set up, and there is no need to use human tissues. These drugs are effective not only in the deficit of growth hormone. For example, they are used to treat short stature with chromosomal abnormalities (Turner's syndrome), intrauterine growth retardation, and chronic renal failure. Preparations of growth hormone have a small number of side effects. However, when they are used, there is a small risk of developing leukemia in the future. However, apparently, this risk is associated with the presence in children of the previous tumor.
Other hormones
To treat hypothyroidism, thyroxine can be administered for oral administration. The production of this hormone is easy, and they are relatively inexpensive. To accelerate growth rates, the onset of puberty and increase in bone age, boys with a constitutional growth retardation may be given testosterone in the form of monthly injections. Such therapy does not always lead to an increase in the final growth, but it allows the child to enter the pubertal period and to go through a growth jump simultaneously with peers.
- Lack of growth hormone can be made up by prescribing its drugs in the form of subcutaneous injections.
- Gigantism is rare; usually its cause is the excessive production of growth hormone by the pituitary gland, as in the case of Robert Wadlow.