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Kids' Health

Measuring Up Growth issues that affect small children. By Dr. Pinchas CohenPublished: April, 2003

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Growth begins when a baby is conceived in the womb. It is a complex process, influenced by a variety of factors that are still being unraveled. As parents, we keep track of our children's growth in many ways: regular weight and height measurements at the doctor's office, replacing outgrown clothes with larger sizes, and comparing a child's size to siblings, cousins and classmates. If a child is not growing normally, most parents become concerned and seek advice from their pediatrician or family doctor. While some babies start life smaller than others, most usually catch up very early in life. For those children who are significantly shorter by age 2 - below the third percentile on standard growth charts - they most likely will not catch up later in life and will probably remain much shorter than other children, and adults, their age. These children have a lifelong medical condition called "small for gestational age," or SGA. In the United States, 3 percent of all babies are born SGA every year. While the majority catch up to normal height by age 2, as many as 10 percent, or about 12,000 annually, do not. As a result, there are as many as 150,000 unique children over the age of 2 who have not caught up and, if left untreated, may never reach their growth potential. SGA is not the same as being born premature, and standard growth charts indicate if a baby is born SGA or simply too early. While the size of a young child with SGA may be considered cute, especially among girls, there is nothing cute about the challenges they face as they get older. Parents can help by working with their pediatrician to pay close attention to growth charts and detect whether there is an underlying medical problem.  Since SGA is relatively rare, many parents are unfamiliar with the disorder and don't know where to turn for help. In major clinics such as the one at UCLA, thousands of patients are seen every year for the evaluation of growth disorders, but many more never get referred in time. Recently, we have been able to address the needs of a growing number of families with children who were born SGA and have initiated treatment with growth hormone under our care. Children with SGA, sometimes caused by a complication or trauma during pregnancy but often of unknown causes, have a difficult time processing growth hormone, which is naturally occurring in their body. They therefore need additional growth hormone to overcome the resistance and achieve normal height. Last year, the Food and Drug Administration approved the growth hormone product Genotropin for the long-term treatment of growth failure in children born SGA. Recombinant growth hormone has been safely used by tens of thousands of children with various growth disorders. Side effects are rare and mainly related to the injection site. If your child was born small (under 5.6 pounds and 18 inches for full-term babies) and does not seem to be catching up by age 2 or more, you should talk to your pediatrician to determine whether you need to see a specialist and whether growth hormone may be appropriate. The earlier medical supervision and treatment occurs, the better off your child will be for two key reasons. The first reason is that studies have shown kids with SGA can have significant academic and social problems related to their small stature, including being left back in school, and having psychosocial problems such as low self-esteem. Experts believe if treatment begins prior to children beginning school, there is a greater chance that their height will begin to normalize and these consequences may be reduced. The second reason for early diagnosis and treatment is that the majority of growth occurs before puberty. Therefore, the older the child before beginning treatment, the less time he has to accelerate growth before growth stops altogether. For more information about SGA and other growth disorders, contact the Magic Foundation at 708.383.0808, or visit www.magicfoundation.org. For information about the growth clinic at UCLA, call 800.UCLA.MD1. Dr. Pinchas Cohen, a pediatric endocrinologist, is professor of pediatrics at UCLA. Growth quiz To determine whether your child might have a growth disorder, take this quick test.  • Was your baby full term, but less than 5 pounds, 6 ounces or 18 inches when he/she was born?  • Do people typically think your child is younger than he/she is?  • Is your child the smallest in his/her playgroup?  • If your physician regularly measures height/weight, is your child below the third percentile? If these questions raise concerns about your child's growth, talk to your doctor and he or she will determine whether your child needs to be evaluated by a pediatric endocrinologist, a specialist in children's metabolic and growth disorders.

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