Question: My 13 year old son is the shortest in the class. Is there any medical condition I should be worried about and is there anything I can give him that will increase his height?
Dr Hina J Shahid: Children’s height is a very common cause of concern for parents, and in the overwhelming majority of cases children are healthy and normal with no underlying medical condition and do not require treatment.
What is normal growth?
Height is predominantly genetically determined. This means that if a child’s parents are short, then they will pass these genes onto their children. The fastest period of growth is in the first year of life. In the first year of life, children grow up to 25cm in height, which after the age of two continues at a steady rate of about 6cm per year, until adolescence. However, there will be periods when this will be faster or slower. Most growth occurs due to elongation of the long bones at the growth plate. The growth spurt is a period of increased speed of growth that occurs during puberty. For girls puberty occurs between 10-14 years and the growth spurt reaches a maximum after two years. Final adult height is reached by the age of 14 or 15 (although this can be earlier or later depending on when puberty started). For boys, this occurs slightly later and growth continues until 16 years, which means your son still has time to grow. When final adult height is reached, the growth plates fuse and no further increase in height can be obtained. The medical definition for short stature is height that is 2 standard deviations below the mean height for age and sex, which means that his height is in the lowest 3% for him to be classified as short. However, if he has always been in this range, and continues to grow at this rate and is otherwise healthy, there is nothing to worry about.
What causes short height?
In the majority of cases, short stature is hereditary. As along as the child is healthy and developing normally, there is nothing to be concerned about. A common cause of short stature is constitutional delay of growth, or “late bloomers”, who start their growth spurt late and will reach their final adult height later than average. Underlying medical causes include malnutrition, certain chronic diseases, hormonal imbalance or deficiency (such as thyroid and growth hormone disorders), genetic disorders and certain medication (such as long term steroids and certain medications for ADHD). However, your child will have other symptoms and signs to suggest this. If you are concerned, you should take your son to his GP for an assessment.
What will the doctor do?
Your GP will look at previous growth charts and see what your child’s growth rate is. The GP will also screen for medical conditions and malnutrition, and then calculate the mid-parental height using yours and his dad’s height. This will give an estimate about your son’s final adult height. Your GP may also arrange tests such as blood tests and X Rays, or referral onwards to a paediatrician or dietitian depending on the findings of the initial assessment.
What is the treatment of short stature?
If an underlying cause has been found by your doctor, this will be treated accordingly. There has been a lot of interest around growth hormone treatment, but this is reserved for those children who have an underlying disorder that is likely to benefit from this treatment. If no cause has been found, it is important to make sure your child has a balanced diet and is getting enough sleep and exercise. With increasing use of digital technology, screen time is increasingly replacing play and sleep time, which can have consequences on children’s growth and development. It is also extremely important as parents for you to maintain your child’s self esteem, and if there are any concerns around bullying at school, that these are reported and dealt with.
Puberty is a time of heightened self consciousness among children, and as parents it is important to not give too much attention to your child being short as it can make children feel low and lack confidence. Instead you should encourage your child by focusing on the things he is good at and encourage healthy behaviours.
Dr Shahid is a GP and Chairperson of the Muslim Doctors Association. She qualified with a distinction in Medical Sciences at University College London and also holds a Bachelors of Science in Pharmacology from University College London, and a Masters of Science in Public Health from the London School of Hygiene and Tropical Medicine. She has also completed a one-year course in Fiqh and Aqeedah at Ebrahim College, London. She currently works as a GP in Central and West London and has an interest in women and children’s health, mental health and public health. She is an honorary clinical tutor at Imperial Medical School and an honorary faculty member at An Najah National University, Palestine at the Department of Community and Family Medicine. She has also worked in research and humanitarian settings in Lebanon, Greece and Calais. In the UK she delivers outreach clinics and health promotion workshops to ethnic minority groups. She is a keen traveller and linguist and enjoys reading and spending time with her family in her free time. She is currently learning Arabic.
Dr Hina J Shahid MBBS BSc (Hons) MScPH MRCGP DFRSH DRCOG DCH
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