He has always been thinner than his teammates, but now that he has grown older, the difference is more noticeable. Should you worry and check your growth hormone? To take exams? To go to the specialist? The answers of Maurizio de Martino, full professor of pediatrics at the university of the city and Head of pediatric auxo-endocrinology at the Meyer hospital of the city.
First of all you need to contact the family pediatrician. Only a doctor has the expertise and technical tools to determine if the child is straying from normal growth. It will be he who will prescribe the first tests and decide whether and to which specialist to refer the family.
Here are the specialist's advice:
- Consider the height of the parents
- Consider the height of relatives
- Look at the growth curves
- How much and until when do children grow up
- Diseases that cause poor growth
- When to go to the doctor and which one
- How to help children grow
The tiger makes cubs and the cat makes kittens: if the two parents are small, the child will not be able to become a tall boy. To find out what is the so-called target age, i.e. the height that your child can be expected to reach, you can do a simple calculation:
- in the case of males, height of the mother + (height of the father + 12): 2;
- in the case of females, height of the mother + (height of the father - 12): 2.
For example, if the father is 180 cm tall and the mother 170 cm, the male child can approximately reach a height of 181 cm, while the female daughter of 169 cm; in both cases, a range of 8 centimeters is considered normal more or less than the target height.
Read also: Child growth, how tall will he be as an adult
The gene responsible for height growth, called the Chop gene, sometimes jumps in generation, then the child could be the height of his grandfather or uncle rather than that of the parents.
To understand whether poor growth is physiological or not, it is also necessary to evaluate whether the child is following his personal growth curve: if as a child he has always been around the tenth percentile and continues to stay on his line, it means that this is the normal growth for him; if, on the other hand, it has been on the 90th percentile for a few years and then has begun to decline, then there may be something wrong.
It depends on the sex ...
A little girl can grow up about 5 centimeters per year until menstruation arrives.
"However, there is a phase in its development where one occurs growth spurt, called Growth Spurt, during which height can increase by 1-2 centimeters per month, "says the pediatrician.
It is a phase that coincides with the third stage of pubertal development, that is, the one in which there is an enlargement of the areola and breast and the appearance of darker and scattered hairs on the pubis.
Once her period arrives, growth slows down and the girl can increase a couple of centimeters in all, therefore the increase in height can be considered concluded ".
A male instead it can grow 3 centimeters a year, but can continue to increase in stature even up to the age of 18-19.
And it depends on bone age.
That is, from the age of growth of the child's skeletal structure, which may not coincide with the age. Bone age is established by taking a specific hand and wrist x-ray, at a pediatrician radiologist (not at the adult radiology department), obviously if the pediatrician deems it appropriate.
What information does the bone age test provide? "Let's take an example" explains de Martino: "if a 10-year-old child is the height of an 8-year-old and it is found that his bone age is actually that of an 8-year-old, that's okay, because it means that his bones still have plenty of time to recover the stature that has not been achieved so far. If, on the other hand, it is found that that child has already reached the skeletal age of 10 years (or, even, a bone age greater than 10 years ), it means that it no longer has many margins for growth and there is the possibility that behind its poor development there is some problem, which must be investigated ".
It is the first aspect on which it is worth investigating. Gluten intolerance, creating malabsorption of foods, can cause a decrease in growth (even if there are celiacs who have a regular growth, demonstrating the fact that medicine is not an exact science). Diagnosis is easily made with a small blood sample, which detects the presence of anti-transglutaminase, anti-endomysium and anti-gliadins antibodies. The biopsy is not used for diangosis, but only to have the exemption for the purchase of foods for celiacs.
A myth to dispel is that the poor growth can be caused by a food allergy. "Only in infants and only milk allergy can cause growth failure: in school-age children, any food allergies cause quite different types of reactions, such as hives, asthma, respiratory manifestations or, in severe cases, anaphylactic shock. poor growth no "says the pediatrician.
A slowdown in growth may also be due to chronic inflammatory bowel diseases, such as Crohn's disease and ulcerative colitis, or to infectious diseases such as tuberculosis or hepatitis B and C. "But these are much less frequent cases and which are accompanied by other signs, different according to the disease "comments de Martino.
Another cause of malabsorption and therefore of poor growth is cystic fibrosis, but screening at birth has been carried out in almost all regions for many years and therefore the presence of the disease is excluded even before being discharged from the nursery.
When a child grows little, parents immediately think about possible hormonal imbalances. "In reality, these are very rare occurrences, due to a congenital deficiency of the growth hormone GH, which leads the child to move further and further away from his growth curve" observes the expert. If the pediatrician suspects a GH defect, he will prescribe a dosage of the hormone.
“We turn to the specialist if e when the pediatrician decides, without resorting to DIY. And the specialist is different depending on the case: pediatrician endocrinologist, pediatrician gastroenterologist or pediatrician infectious disease specialist. The important thing is that it is always of doctors specialized for paediatrics, because adults and children are completely different biological entities and the child needs the specific expert for his age ”underlines Maurizio de Martino.
Sport is certainly useful for growth and the ideal sport is… what a child likes, as long as he does it! It was demonstrated that those who play sports reach a height of 3 - 5 cm higher than the target height.
For females there is one more consideration: those who practice sports are generally thinner and, since the start of menstruation starts from a message from the pituitary gland that takes into account the relationship between weight and height, the athlete has more time to grow with respect to those who, more 'fleshy', menstruate earlier.
Children and adolescents must be guaranteed an abalanced portion of noble proteins, ie meat, fish, milk, dairy products and eggs; equally important for its diet, even if a little less rich in noble proteins, are the legumes, such as beans, chickpeas, lentils.
"Proteins are the essential 'building blocks' for growth and children need at least one pound of protein food a day, 5 times a week" is the pediatrician's comment.
Supplements in a child on a normal diet are of no use at all.
- if the child does not grow up
- back in growth
- short child
- 3-5 children years