If the bone age does not correspond to the biological age, this gives reason to diagnose growth retardation. Short stature manifests itself in millions of people, it does not always cause discomfort and has different origins. In case of severe pathologies, other symptoms are observed in addition to stunting. In some cases, the patient can get normal height only with help of leg lengthening surgery. At Ladisten, the clinic of modern orthopedics and traumatology, such surgical operations have been carried out for over 30 years.

Задержка роста у детей

Causes of growth retardation

Growth retardation may appear because of many reasons. We will look only at the main ones in the table:

 Pathology  Growth retardation ICD-10  Cause
 Family-related short stature  Short stature not classified in other chapters 34.3  Short height in parents (150-165 cm)
 Constitutional growth delay  Short stature not classified in other chapters 34.3  Delayed growth spurt
 Psychosocial growth delay  Short stature not classified in other chapters 34.3  Psychological atmosphere in the environment where the child is growing, a dysfunctional family
 Somatogenic growth delay  N25.0, K90.0, E24.2 and others  Develops as a consequence of past diseases of the heart, kidneys, respiratory organs
 Hereditary syndromes  Q96, Q87.1  Various syndromes: Shereshevsky-Turner, Noonan, Russell-Silver syndrome
 Chondroplasias  Q77.0–Q77.9  Disproportionate skeletal structure
 Growth retardation in case of hypothyroidism  E03.0– E03.9  Thyroid pathologies
 Hypopituitarism, including somatotropic insufficiency  E23.0, E23.1, E89.3  Deficiency of growth hormone or several pituitary hormones. May be caused by a tumor or a failure of the pituitary gland

Symptoms of delayed growth

There is one main symptom of growth retardation – the inconsistency of growth parameters with the established norms at different stages of life. Depending on the form of the process, there are some nuances:

  • constitutional growth delay is accompanied by normal hormone production. Body height and weight at birth are normal. A pronounced delay occurs at the age of 3-4 years, and then the process of growth is restored. Bone age lags behind the passport age by 1-2 years. There is a delay in puberty by 2-4 years in children, but the growth plates also close later. Therefore, the growth process eventually becomes normal and the condition does not require treatment;
  • family-related short stature. At birth, the parameters of height and weight are normal. The pace slows down after 3-4 years, the child grows by 2-4 cm per year. Bone growth does not lag behind the chronological, and hormones are produced normally. Puberty is on time;
  • hormonal deficiency is manifested by the most severe and pronounced symptoms. In case of growth hormone deficiency, the growth rates and bone age lag significantly behind the norm. The delay is visible already at 2 years of age. Facial features change: they become small, “doll-like”, excess body weight appears. Boys often have a micropenis;
  • in case of tumors causing short stature, neurological symptoms and visual impairments appear.

In order to determine the exact cause, qualified diagnostics should be carried out.

Diagnostics

Growth retardation is mainly determined by endocrinologists, but a consultation of an orthopedist should be additionally appointed. First, the doctor collects medical history and calculates the target height of the child. Parents’ genetics and nationality play a significant role. Other diagnostic points include:

  1. Anthropometry. This includes assessment of three parameters – growth SDS, growth rate, growth rate SDS. They show how the child’s physical development corresponds to age standards. A percentile curve needed for making diagnosis and for choosing treatment tactics is established. SDS stands for Standard Deviation Score, or the standard deviation coefficient.
  2. Determination of body proportions. A proportional body build indicates the absence of dysplasia.
  3. X-ray. For a complete visualization of the structure of the skeleton, an X-ray is taken. Radiography of the hands determines bone age.
  4. Laboratory tests. Most diagnoses are confirmed with blood tests. In addition to general indicators, the values ​​of glucose, gliadin and transglutaminase antibodies, T4 and TSH hormones are important. Also GH stimulation tests, karyotyping and IGF-1 (insulin-like growth factor-1) determination are carried out.

Growth retardation in children: clinical recommendations

If you suspect short stature in your child, you need to find out its exact cause:

  • pay attention to the increase in height during each examination carried out by the pediatrician. Normally, it should not be less than 3 cm per year;
  • if the baby does not gain weight well and there is no height increase, you should visit an endocrinologist as soon as possible;
  • at the next stage, a complete examination is required to make the correct diagnosis. X-rays and an orthopedic examination can be done at the Ladisten Clinic.

Treatment

Growth retardation is treated depending on its cause. If the child does not have enough growth hormone, HGH injections are prescribed. The dose and scheme are adjusted according to the results of the increase in body height. The earlier such treatment is started, the more favorable the outcome. Also, steroids and some hormonal drugs are used to correct the process of growth in addition to growth hormone.

Many conditions cannot be treated with medication. These include the hereditary factor, genetic mutations, dysplasias. Therefore, people decide to take the only possible option – height increase surgery. This is possible thanks to modern technologies and the improved Veklich fixation device. At Ladisten Clinic, minimally invasive surgical operations which make it possible to add 5-10 cm to the patient’s height with practically no blood are performed. We are waiting for you at Ladisten and are always ready to provide a consultation!


Sourses

¹CHILD DISEASES Edited by Professor N.А. GEPPE TEXTBOOK 2017. Ministry of Education and Science of the Russian Federation Recommended by the Coordination Council for the field of education “Healthcare and Medical Sciences” as a textbook for use in educational institutions implementing basic professional educational programs of higher education in the areas of specialty training 05/31/01 “General Medicine”, 05/31/02 “Pediatrics “.

²https://www.cdc.gov/growthcharts/who_charts.htm

³FEDERAL CLINICAL RECOMMENDATIONS FOR DIAGNOSTICS AND TREATMENT OF IDIOPATIC LOW GROWTH IN CHILDREN AND ADOLESCENTS, Moscow-2013.