Growth: How Does Your Child Measure Up?
While there are some children who start life smaller than others, most of them usually catch up very early in life. However, for those children who are still significantly shorter by age two—below the third percentile on standard growth charts—they will most likely not catch up later in life and will probably remain much shorter than other children their age, and continue to be short as adults. These children have a lifelong growth disorder called “small for gestational age,” or SGA.
In the United States, three percent of all babies are born SGA every year. While the majority catch up to normal height by age two, 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 two who have not caught up and, if left untreated, may never reach their growth potential. And 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. New 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. A recent patient of mine, a full-term baby was small at birth, weighing just 4 lbs. 13 oz. and measuring less than 18 inches. By age 4 he was shorter than 97 percent of children his age. I concluded that he suffered from SGA. Although he was producing sufficient growth hormone, he was not growing at a normal rate and never achieved “catch up” growth. I began daily injections of a growth hormone called Genotropin, FDA-approved for the treatment of SGA. He experienced no major side effects from treatment with growth hormone, the most common being injection site reactions and eczema. Since he began treatment, he has grown approximately four inches a year and has caught up in size to his classmates.
Caused by a complication or trauma during pregnancy, it is believed that children with SGA have a difficult time processing growth hormone, which is naturally occurring in their body, and therefore need additional growth hormone to overcome the resistance and achieve normal height.
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, including being left back in school, shyness and low self-esteem. Therefore, experts believe if treatment begins prior to children beginning school, there is a greater chance that their height may 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 a child is before beginning treatment, the less time he or she has to accelerate their growth and catch up to normal height—before they stop growing all together (usually in their mid teens for girls and late teens for boys).
For additional information about SGA and Genotropin, please visit www.genotropin.com, and for information about other childhood growth disorders contact The Magic Foundation at www.magicfoundation.org or (708) 383-0808.#
Paul Saenger, M.D., a pediatric endocrinologist, is an attending physician and professor of pediatrics at The Children’s Hospital at Montefiore Medical Center and Albert Einstein College of Medicine in New York.