Abnormal Growth

Growing is a big part of your child’s life, from tracking height with pencil ticks on the wall to a
shopping trip to replace outgrown clothing. Growth refers to the physical and developmental
milestones that most children will reach at certain ages. If your child is growing too slowly or too
quickly, the Pediatric Endocrinology, Diabetes and Metabolism Service at Michigan Medicine offers
comprehensive treatment plans for children of all ages who face a variety of growth challenges.

Typically, from the age of 3 until puberty, a child should grow at least two inches each year. If your
child appears to be growing too slowly – or too quickly – an evaluation is warranted.

A variety of disorders of the endocrine system can affect growth, including:

 Growth hormone deficiency

 Hypothyroidism – thyroid gland doesn’t produce enough thyroid hormone
 Hyperthyroidism – thyroid gland produces too much thyroid hormone
 Excess cortisol production
 Congenital Adrenal Hyperplasia – too much androgen hormone
 Turner syndrome – a chromosomal condition in girls
 Precocious puberty – entering puberty early
 Delayed puberty – entering puberty late

Our team thoroughly evaluates each child with a physical examination and analysis of the growth
pattern over time. Often it is necessary to obtain blood tests and an X-ray of the hand to understand
bone growth. We also consider family growth patterns. If indicated, we will recommend the treatment
needed to replace a missing hormone, or suppress hormones that are too high.

What causes growth problems in a child?

Growth disorders can have many causes. Causes usually fall into one
of the following groups:

 Familial short stature. This means a child's height is part of his or

her family's pattern of inherited short height.
 Familial tall stature. This means a child's height is part of his or her
family's pattern of inherited tall height. 
 Constitutional delay of growth and pubertal development. This
means a child tends to be shorter than average and to enter puberty later
than average, while growing at a normal rate. This may be inherited.
These children tend to catch up in time and reach their normal adult
height.
 Illnesses that affect the whole body (systemic diseases). This
includes constant malnutrition, digestive tract diseases, kidney disease,
 heart disease, lung disease, diabetes, or chronic severe stress. Any of
these conditions can cause growth problems.
 Endocrine (hormone) diseases. Growth can be affected by some
conditions that disrupt hormones. Thyroid hormone is essential for
normal bone growth. The pituitary gland at the base of the brain secretes
several hormones, including growth hormone. Growth hormone
deficiency can result from injuries to the pituitary gland or brain. Cushing
syndrome can impair height but cause weight gain. Precocious puberty is
a condition caused by hormone problems. It often causes fast growth and
tall height compared with other children of the same age. But growth
stops at an early age. As a result, children with precocious puberty may be
short as adults.
 Giantism. Children will grow faster than normal if their pituitary
gland makes too much growth hormone.
 Intrauterine growth restriction (IUGR). This means growth of a
baby in the uterus is slowed. This can be caused by many factors, such as
smoking during pregnancy or not enough prenatal care. The baby is born
smaller in weight and length than normal.
 Genetic disorders. This includes Turner syndrome, Down
syndrome, and achondroplasia. Turner syndrome is when having too
many, too few, or disrupted chromosomes results in health problems. It’s
a common genetic disorder that occurs only in girls. It causes poor growth
and delayed or no puberty. Turner syndrome occurs in 1 in 2,500 girls. It’s
caused by one missing X chromosome. Down syndrome is another
common genetic disorder causing poor growth and short stature. It
results from an extra 21st chromosome. Achondroplasia is the most
common genetic bone disease. It causes a child’s arms and legs to be
short. It also causes a large head and other features.
Most of these disorders that can cause growth problems are idiopathic.
This means their cause is not known.

Which children are at risk for growth problems?

Risk factors for growth problems include:

 Family history
 Systemic disease
 Genetic disorders

What are the symptoms of growth problems in a child?

Most growth problems are noticed when the child appears smaller than
his or her classmates, or when growth slows over several months.
One main sign of a growth problem is when a child grows less than 3.5 cm
(about 1.4 inches) a year after his or her 3rd birthday. In other cases, a
baby may be abnormally small for his or her gestational age at birth.

Growth problems may be part of other problems or health conditions.

Make sure your child sees his or her healthcare provider for a diagnosis.

How are growth problems diagnosed in a child?

In some cases a growth problem may be diagnosed at birth, when a baby
is abnormally small for his or her gestational age. In other cases, a growth
problem may be diagnosed when a child's growth is checked during
regular exams. 

Diagnosis of a growth disorder must be made by your child's healthcare

provider. He or she may work with a pediatric specialist. The healthcare
provider will ask about your child’s symptoms and health history. He or
she may also ask about your family’s health history. He or she will give
your child a physical exam. Your child's health and growth may be
checked over several months.

Your child may also have tests, such as:

 Blood tests. These are done to check for hormone, chromosomal,

or other disorders that can cause growth problems.
 X-ray. This test uses a small amount of radiation to make images of
tissues inside the body. An X-ray may be done of the left hand and wrist.
This can estimate your child's bone age. With delayed puberty or hormone
problems, bone age is often less than calendar age. 
 How are growth problems treated in a child?
Many conditions that cause growth problems can be managed or
corrected with medical treatment. Treatment for growth problems will
be based on:

 What may be causing the growth problem

 How severe the problem is
 The child's current health and health history
 The child's ability to deal with medical procedures and take
medicines
 The parents’ wishes about treatment

What are possible complications of growth problems in a child?

Some children may have poor self-esteem or depression because of their
height.

How can I help my child live with growth problems?

Children who are shorter or taller than their peers may have poor self-
esteem or depression. It’s important to talk about these problems with
your child and your child's healthcare provider. He or she can recommend
support groups for you and your child.

Talk with your child's healthcare provider about your child's potential
adult height. If your child's growth problems are caused by a condition
that can be treated, work with your child's healthcare providers to create
an ongoing plan to manage your child’s condition.

When should I call my child's healthcare provider?

Talk with your child’s healthcare provider if you are concerned about your
child's growth.

Key points about growth problems in children

 A growth problem means that a child falls either below or above the
average range of growth for a child's age, sex, family history, or racial
background.
 Growth disorders have many causes. They can include genes, illness,
or problems with hormones.
 Most growth problems are noticed when the child appears smaller
than his or her classmates, or when growth slows over several months.
 One main sign of a growth problem is when a child grows less
than 3.5 cm (about 1.4 inches) a year after his or her 3rd birthday. In other
cases, a baby may be abnormally small for his or her gestational age at
birth.
 Many conditions that cause growth problems can be managed or
corrected with medical treatment.
 Children who are shorter or taller than their peers may have poor
self-esteem or depression. It’s important to talk about these problems
with your child's healthcare provider. He or she can recommend support
groups for you and your child.