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Children with short stature, what to do?


There are light-eyed children and dark-eyed children; curly-haired and straight-haired; calm children and nervous children. The spectrum of the human condition is so broad that we could use page after page naming childlike qualities. However, if there is a fact that worries parents, it is the size of their children, especially if it is smaller than they expected.

What does the child's growth depend on? Growth is the result of the interaction of the child's own factors (genetics, hormones, metabolism) and factors external to the child (nutrition, physical activity, etc.). The former determine between 50% and 80% of the adult size.

When is a child said to be short? First, let's define the situation. We pediatricians say that a child is “short” if his height is below the 3rd percentile. This means that 97% of the population is taller than he is.

What Causes Short Height in Children? The causes are various:

1.-Not pathological. The most frequent causes are totally benign and do not require any treatment: familial short stature (FBR) and constitutional growth retardation (RCC). Children with TBF stand out for their family history: they are healthy children, harmonically short, and children of short parents, and they will always be short. Children with RCC are children who, around 2-3 years of age, suffer a growth deceleration, which is compensated later, since they have puberty later than usual (around 15-16 years). This fact makes them reach a final height similar to that of the general population (they are short in childhood, but normal height in adulthood).

2.-Pathological. They are divided into two large groups, depending on whether the body is well proportioned (harmonic short stature) or not (disharmonic).

-Low harmonic size. It can originate before birth (infections during pregnancy, diseases of the placenta, chromosomal abnormalities, etc.) or after (malnutrition, chronic diseases, hormonal disorders).

-Low disharmonious size (due to bone diseases, such as rickets or dysplasias).

How is short stature detected in children? At health check-ups, both pediatricians and nurses dynamically assess the child's weight, height, and head circumference. More important than knowing in a timely manner which percentile the child is in, it is important to look at the child's growth rate. A significant percentile drop, or an unsatisfactory gain in centimeters, can indicate that something is wrong. If your pediatrician suspects that your child has pathological short stature, he will refer you to a specialist in pediatric endocrinology.

When is it necessary to treat with growth hormone? The current indications to start treatment with growth hormone in children with short stature in Spain are the following:

-Growth hormone deficiency.

-Turner syndrome.

-Chronic renal failure.

- Prader-Willi syndrome.

-Newborn small for gestational age.

-Mutations of the SHOX gene.

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