THE SPECIALIST: Dr. Robert Rapaport
Professor of Pediatrics at Mount Sinai, Dr. Robert Rapaport treats children for every kind of endocrine problem, from growth issues to diabetes to thyroid problems. The majority of his patients have growth problems.
WHO’S AT RISK
From the first months of a baby’s life, many parents start spouting weight and length measurements and growth percentiles. As it turns out, measuring a child’s growth is about much more than competitive parenting.
“For parents and pediatricians, growth is an excellent measure of health and well-being — if the child is otherwise well, the child is likely to grow well,” says Rapaport. “If not, the lack of growth could be a sign of underlying health problems, including any chronic illness, inflammatory bowel disease, celiac disease, hypothyroidism or even growth hormone deficiency. The good news is that many of the conditions that slow growth are treatable.”
A common misperception is that the words “growth” and “height” are interchangeable. “Stature is your height, while growth measures the rate at which children are increasing in size,” says Rapaport. “Growth failure is a problem, but being short may not be. If the child is otherwise healthy and growing well, height matters much less.”
The key for parents is to make sure that all children’s growth is being measured and tracked regularly at the pediatrician’s office. “Infants should have their head circumference and [body] length measured as well as weight, while standing height is measured starting age 3,” says Rapaport. “After infancy, children should no longer change growth percentiles.”
While the vast majority of children grow normally, growth problems are not rare. “Growth issues are by far the most common referral for pediatric endocrinologists, and some speculate that as many as 1 in 3,500 children have growth hormone deficiency,” says Rapaport. “Growth issues can affect anyone, and parents should be equally concerned with the growth of boys and girls.”
The number one cause of growth failure worldwide is malnutrition, which is rare in the U.S. “The first thing we check is that children take in enough calories, and second, that they absorb them — for instance, celiac disease is often diagnosed due to growth problems,” says Rapaport. “Another leading cause is growth hormone deficiency, which is quite treatable and common.” Abnormal kidney, cardiac or liver function can also hinder growth, as can some chromosomal abnormalities.
SIGNS AND SYMPTOMS
Since being short alone isn’t necessarily a sign of growth failure, what should parents look out for? “The chief warning sign is if the child’s height percentile decreases over the years, and another thing parents frequently notice is that the child isn’t keeping up with siblings or peers,” says Rapaport. “Low blood sugar levels or a chubby body out of proportion to thin limbs with poor growth can also be clues of growth hormone deficiency.”
Doctors and parents should all be on the alert to monitor children’s growth. “The pediatrician should be plotting the height percentiles carefully because if the percentiles are decreasing, that’s a cause for concern,” says Rapaport. “It’s not only a question of whether the child is short or of normal height, but also of whether he or she stays in the same percentile as before. Extreme short stature also may need to be investigated.”
No parents want to hear that their child has a growth problem, but the majority of cases are correctable. “The treatments are directed to the underlying condition, whether it’s celiac disease, hypothyroidism or growth hormone deficiency,” says Rapaport. “Most of these diagnoses can be treated specifically with the result of improved growth.”
Growth hormone therapy has been a controversial topic of late, with some parents wanting to use the treatment to alter their child’s natural height. “Growth hormone therapy should not be used for cosmetic purposes, but it is the treatment of choice for true growth hormone deficiency,” says Rapaport. “If a child isn’t growing well, then the doctor can recommend that they receive a special three-hour test to measure growth hormone and an MRI of the pituitary gland.” The FDA has specific indications to guide who is a candidate for growth hormone therapy.
Children with growth hormone deficiency should receive treatment with synthetic growth hormone. “It’s given by daily injections, and while the therapy seems to be extremely successful overall, there can rarely be side effects for which routine but regular monitoring is indicated,” says Rapaport. “In some cases, we continue treating these children into adulthood, because the hormone is important for other metabolic functions, like keeping your muscles and bones in shape.”
Sometimes, the right treatment is no treatment. “One of the hardest things is convincing families that their children don’t need treatment,” says Rapaport. “I like to remind them that the world’s best soccer player, [Lionel] Messi, had growth hormone deficiency — and is far from tall. The most important message is that children can be equally successful at any height in all professions, including sports.”
Doctors are on the hunt for new ways to help children achieve their growth potential. “It used to be thought that if you are born small, you remain small, but now we can successfully treat these patients with growth hormone,” says Rapaport. “We at Mount Sinai are in the midst of planning a multidisciplinary, family-centered comprehensive growth center, where under one umbrella we could investigate and treat all the potential causes of growth failure.”
QUESTIONS FOR YOUR DOCTOR
A good way to open a conversation about growth with your child’s pediatrician is, “Are there deviations from the norm in my child’s growth chart?” Once a child is experiencing growth problems, parents often ask, “Is there a window for intervention?”
“The overall message is that height alone doesn’t matter as much as growth rate,” says Rapaport. “But if a problem is identified, there’s a lot that can be done to improve your child’s growth, and ultimately, adult height.”
WHAT YOU CAN DO
Get informed. Two trustworthy online sources are the Human Growth Foundation (hgfound.org) and the Magic Foundation (magicfoundation.org).
Track growth. Rapaport recommends that all parents monitor their children’s growth in terms of height (length in small children), weight and BMI.
Put it in perspective. “The earlier growth issues are identified and the earlier treatment is initiated, the better the results,” says Rapaport.