Pediatrics

Stunted growth

definition

Growth disorder is the phenomenon that the size, length or shape of a certain body section or the entire body deviates from the norm either due to excessive or reduced growth.

Often, growth disorders are mainly understood to mean growth in length, i.e. a different height of the person concerned. A distinction is made between short stature and tall stature.

Furthermore, a distinction is made between primary (= congenital) growth disorders and secondary (= acquired) growth disorders:

In the case of congenital growth disorders, there is often a defect in the genetic material that causes excessive or reduced growth.
Acquired stunted growth can have many causes and appear for the first time in infancy through teenage years. The affected patients are mostly children and adolescents.

causes

Congenital growth disorders often manifest themselves at birth as a result of a low birth weight and reduced body length and can thus be detected by ultrasound examinations before birth.

In other cases, the child has a normal birth weight and does not gain corresponding weight in the newborn or infancy. One possible cause of this is chromosomal abnormalities, in which the number or structure of the chromosomes (normally 46, XX in women or 46, XY in men) is changed, which manifests itself in a variety of symptoms and physical abnormalities. For example, Down syndrome (trisomy 21) or Turner syndrome (women with only one X chromosome) are associated with reduced body size. Other genetic defects (e.g. osteogenesis imperfecta, the glass bone disease) are also associated with short stature.

Furthermore, hormonal imbalances can lead to growth disorders. This can be congenital or acquired, a well-known example is the underactive thyroid (hypothyroidism). Intestinal diseases such as celiac disease can lead to stunted growth due to malnutrition, as can malnutrition or malnutrition due to insufficient food intake.

Finally, certain forms of medical treatment, especially chemotherapeutic agents for cancer, long-term use of cortisone or radiation therapy, can lead to growth disorders.

A growth disorder should be distinguished from phases in which children are growing faster than usual, but they are completely normal. You can find more on this topic under: Growth spurt

You might also be interested in: Baby growth spurt

Cortisone growth disorder

Cortisone is a endogenous hormonewhich means that the human body itself constantly produces small doses. It fulfills numerous important functions in the body, primarily the Anti-inflammatory serve.
As a drug, cortisone is often used in children as a spray or tablet Therapy of bronchial asthma used. Even with numerous skin diseases such as Neurodermatitis Cortisone is used in ointment form.

This is decisive for the occurrence of side effects amount cortisone, which is absorbed as a tablet through the intestine or as a spray through the lungs or as an ointment through the skin and enters the body's circulation. Here it can be via complicated control loops (based on the principle of negative feedback) among other things Suppressing the body's production of growth hormones. It results in a Short stature, however, this happens only with long-term therapy with high doses Cortisone.
For this reason, the doctor should always critically review the dose of cortisone and choose the lowest possible dose.

Stunted growth from a broken bone

In the case of broken bones in childhood, there is a general risk that incorrect healing will lead to growth disorders. Depending on the type and location of the break, either excessive or reduced growth of the healing bone is possible.

Shaft fractures (in the middle part of long tubular bones of arms and legs) or epiphyseal fractures (bone fractures in the area of the growth plate, usually in joint fractures) harbor an increased risk of subsequent growth disorders.

If only one extremity is affected, two legs and arms of different lengths can result. In the long term, this can lead to premature joint wear (osteoarthritis) and the need to wear special orthopedic shoes with heels, particularly in the area of the legs. For this reason, broken bones in children should always be adequately treated and the healing checked.

Read more on the topic: Short stature

Concomitant symptoms

A growth disorder is not an independent disease but occurs in the context of a variety of diseases, syndromes, therapies or other circumstances. The symptoms that accompany short or tall stature depend on the cause of the growth disorder:

If a growth disorder occurs as part of genetic changes such as chromosomal disorders (e.g. Down's syndrome), the children show a variety of other external abnormalities (e.g. the typical "mongoloid" eye shape, a sticking out tongue, small ears) and internal diseases such as heart defects.
In other genetic diseases such as vitreous bone disease, the bones break very easily and the entire skeleton shows specific deformations.
Celiac disease (gluten intolerance) also has symptoms such as diarrhea or flatulence.
If short stature is caused by an underactive thyroid, those affected often also suffer from fatigue, constipation, a too low heartbeat and dry skin.
If there is a reduced release of growth hormone, then in addition to a short stature, the blood sugar level tends to be too low and the amount of adipose tissue is reduced.
Excessive growth hormone production leads to tall stature and enlargement of the acres (nose, chin, fingers) and internal organs (e.g. heart, cardiomegaly).

Also read:

Growing pains
Growing pains in the knee

Short stature

In short stature, the body length deviates from the norm and is too short. In adults, a height of less than 150 cm is called short stature.

Children are stunted if they fall below the third percentile. Percentiles are growth curves for specific age groups and indicate the normal distribution in the population. Falling below the third percentile means that only 3% of those of the same age are shorter.

Distinguishing short stature with disease value from purely constitutional short stature (e.g. if both parents are very small but healthy) can be difficult here. In general, a distinction is made between congenital and acquired factors (see causes).
Furthermore, a proportioned short stature, in which all body parts are evenly distributed too small, is distinguished from a disproportionate short stature, where only individual body parts such as the extremities are too short.

Read more on this topic at: Short stature

Tall stature

A tall stature is when the body length is above the 97th percentile, i.e. only 3% of those of the same age are taller. For adults in Germany, this is the case for women over 180 cm and men over 192 cm, although there is not necessarily a disease.

In the case of familial (original) tall stature, the growth is not pathological, the proportions and the size of the internal organs are adapted to one another. A tall stature can also appear proportioned or disproportionate.
Certain chromosome changes can lead to both proportioned and disproportionate tall stature. Certain hormone changes, such as the excessive release of growth hormones, can lead to tall stature. Several organs affected can be affected: in the brain the hypothalamus (e.g. in Sotos syndrome) or the anterior pituitary gland (acromegaly), the adrenal glands, the thyroid gland (tall stature due to an overactive thyroid) or the gonads.

In some cases, a tumor (benign or malignant) is found in the corresponding organs, which produces more hormones and releases them into the bloodstream.

You can find the main article here: Tall stature

diagnosis

The direction in which a diagnosis is carried out depends from the beginning of stunted growth and the accompanying symptoms from.
Congenital growth disorders that are discovered before birth or in the first few months of life are often due to one Genetic defect traced back. The combination of certain symptoms raises the suspicion of specific diseases and syndromes, so that special genetic studies can be carried out.
With acquired growth disorders, the accompanying symptoms point the way. A Celiac disease is a possible cause of additional diarrhea and is caused by a Gastroscopy diagnosed. A Thyroid dysfunction or altered levels of growth hormones can be determined by determining the levels of hormones in the blood.

About the anamnese can remember Broken bones or taking medication (Cortisone) as the cause he asks become.

Treatment / therapy

A growth disorder is treated by addressing the underlying cause, if possible:

At a Thyroid dysfunction a normal metabolic state can be achieved with medication.
At a Celiac disease Absolutely no gluten is essential.
Broken bones should always be treated correctly and stabilized as quickly as possible in order to prevent growth disorders.
Are medical therapies like Cortisone cause of stunted growth, the dosage should be adjusted.
In the case of genetic diseases (Vitreous bone disease) or syndromes (Down syndrom) a causal treatment is not possible. It must be decided through individual weighing whether artificial growth hormones should be injected here.
In some cases there is a short or tall stature without disease value (constitutional, family-related) in front. Treatment is not absolutely necessary here, but it can improve the quality of life.

Duration

With a few exceptions (temporary malnutrition or use of cortisone) If there is a growth disorder, there is a genetic defect or a chronic disease underlying. For this reason, a wax disorder does not "heal" easily.
A Growth in length is only possible until the Close growth plates of the bones (epiphyseal plates). Because of this, it is important to stunted growth easy to recognize and to to treatso that a normal height can be achieved by the end of puberty.

As part of the U-examinations, the pediatrician checks the Body size compared with peers (Percentiles) and can thus carry out further investigations when these growth curves are exceeded or fallen below.

Stunted growth in various parts of the body

On the knee

Stunted growth can straight often on the knee joint during puberty occur. In Osgood Schlatter's disease, especially in very sporty adolescent boys, after excessive exertion, pain, protrusions and overheating at the attachment of the patella ligament (ligamentum patellae) occur. The X-ray shows changes in the growth plate. The reason for this is that in growth phases the bone grows faster than the adhesive tape. Conservative therapy with painkillers, rest and cooling is usually sufficient, but the symptoms can persist for months and recur. Surgical treatment is very rarely necessary; the disease usually heals without permanent damage.

Also through Broken bones involving the knee joint and the growth plate stunted growth can occur. From this one can Leg length difference (two legs of different lengths) result, which can lead to osteoarthritis (joint wear) and a limping gait.

On the spine

Especially common with male adolescents it depends on the Spine to a growth disorder, the so-called Scheuermann's disease. There is an ossification disorder of the thoracic spine (less often the lumbar spine), risk factors are tall stature and poor posture. Most of the patients did no pain, these often only appear in adulthood.

It can also become a Hunchback (kyphosis, humpback) and chronic back problems in adulthood. In the X-ray you can see so-called Wedge vertebrae, because the anterior parts of the vertebral bodies grow more slowly than the posterior parts.

When the disease in early stages is recognized, therapy is through physiotherapy and wearing one Corsets sufficient, the prognosis is good. In later stages a operative therapy become necessary.

Which doctor treats growth disorders?

Growth disorders usually require the interdisciplinary treatment with doctors multiple disciplines. Since children are often affected, the Pediatrician mostly involved. In addition, the skeletal changes are also Orthopedists involved.

If there are hormonal imbalances, then Endocrinologist necessary. Depending on the specific clinical picture, other specialist disciplines can be brought on board.

Homeopathy for stunted growth

Homeopathic Therapies can complementary be used for stunted growth.

But because of a growth disorder in part serious illnesses (Syndromes, deficiency symptoms) are the basis, so is one Homeopathic therapy alone is not recommended.
Since in puberty, after the growth plates have closed, no further length growth is possible and a missed growth may no longer be made up, so not too much time should be spent on homeopathic experiments.

A early gear to the doctor is definitely advisable.

You can find more information on the topic here: homeopathy