Helping Your Child Reach Greater Heights

More are seeking help to address growth-related issues for ‘late bloomers’. According to Dr Warren Lee, Senior Consultant & Endocrinologist, this heightened awareness is important in not just becoming taller, but identifying potential medical issues as well.

As the “short fat kid” in class, Dr Lee knows what it is like to be on the lower end of the height scale. The diabetes researcher and paediatric endocrinologist today helps ensure other ‘short kids’ meet their maximum potential height. A growth problem is typically considered a medical issue if a child is smaller than 95 percent of children their age.

When it comes to growth issues, Dr Lee said, waiting is not the answer. Instead, he encourages parents to bring in their children as early as possible – if only to gain rule out existing issues. Two groups of children in particular benefit from seeing an endocrinologist, he explained – those who are not growing very well and are small or short for their age, and the those who are growing too well.

His job: to assess if the pace of growth is normal and reassure parents. “If it is not, it is important to pick up growth problems early so that we can do something.” Ideally, this should be done before a child reaches puberty, and as early as age 6 or 7. “Any intervention should be done early, the earlier the better, before the bones fuse,” he explained. Growth stops about two to three years after the voice changes in boys and the start of menstruation in girls.

Calibrating growth

Using charts, formulas and taking reference from the height of family members, Dr Lee plots a child’s projected height pattern to assess whether or not he or she is meeting all growth development markers and projected height. Using this data, he is able to map out a treatment plan. This usually entails using a carefully titrated regime of growth hormones to adjust the pattern of growth.

One issue that Dr Lee sees is early or precocious puberty. “With early onset puberty, growth ‘burns’ out too early and the child ends up being shorter than they could be,” he said. “What we can do is we can now actually modify the pace of growth and delay puberty.”

While awareness is growing that there is help available, there are still children who are not treated because it is assumed that the kids will catch up and hit their growth spurt eventually. But, he emphasised, a wait-and-see approach is not advisable as once the bones have fused, there is nothing that can be done.

More than height

And there is a lot more to growth issues than gaining a few centimetres. For one, being smaller or shorter than their peers can lead to bullying and self-esteem issues. More significantly, there can be medical implications, said Dr Lee.

Untreated growth disorders signal hormone imbalances and auto-immune disease. For example, low levels of the hormone thyroxine, can delay growth and lead to low energy, constipation, dry skin, dry hair, and trouble staying warm. Growth issues can also be an indicator of stomach or bowel disease as well as celiac disease, which prevents the absorption of nutrients.

“The same chemistry that causes early puberty and short stature is also linked to diabetes risk,” Dr Lee elaborated. “In less extreme cases, it merely causes short heights but in more severe cases, it can increase the risk of developing diabetes later in life.” There are also problems such as a lower muscle mass and bone mineral density, and a higher risk of high cholesterol and diabetes.

Identifying and understanding these issues and risks go a long way to ensuring that the right and timely intervention can be initiated. “Effective treatments are available to ‘buy’ children time and give them a bit more time to grow,” he said. “Any height gains, even just 5cm, compounds like interest over time. So, it all adds up.”