Right Parenting - My child is short! Can we make him Tall?

What are the factors that determine height?

The normal height, in fact normal growth of a child in general is determined by a number of factors. Height of parents determines the genetic potential and familial trend. Hormones like growth hormone and thyroid hormone play important physiologic role. Good psychosocial environment – (parental love and nurturing) and proper nutrition are perhaps the most important determinants.

What is normal pattern of height-gain?

The height or rather the length of the newborn baby is approx. 50 cm or 20 inches. By 1 year, it usually increases by 25cm (10 inches) and reaches up to 75 cm (30 inches). During second year, it gains 12.5 cm (5 inches) and during third year, 7.5-10 cm (3-4 inches). Thereafter till the age of twelve years, the yearly height gain is 5-7.5 cm (2-3 inches).

After puberty, in adolescent years, height gain is again faster. In those years, girls gain around 8 cm (3inches) per year and boys a bit more i.e. 10cm (4 inches) per year.

Can we predict adult height of a child from his childhood height?

There are various statistical formulae to predict adult height of a child. As usual, they provide only a general indication and are not considered as absolute fool-proof ones. The simplest one- Tanner’s formula- says the adult height is double the child’s height at two years. Another formula of Tanner tells us that to get adult height from child’s height at three years, we have to multiply it by 1.87.

Can we predict child’s height from parents’ heights?

Yes, the statisticians have even worked out this riddle for us. If ‘A’ is father’s height and mother’s is ‘B’, then (A+B)/2 is called the mid-parental height. (Mid-parental height+ 6.5 cm) for boys and (Mid-parental height – 6.5cm) for girls is called the Corrected Mid-parental height. (Don’t ask me what all these terms mean! Ask the statisticians!)

So the anticipated adult height for a child – male or female is equal to this corrected mid-parental height, give or take 8 cm here or there.

What exactly is short stature?

Short stature is defined as height that falls below than normal range when compared to others with same age, sex and ethnic background and also taking into consideration – heights of other family members.

What are the important causes of short stature?

Constitutional delay in growth and familial short stature are two common conditions that are not considered diseases but they are just variations of normal height/ growth pattern. Malnutrition, lack of parental affection and nurturing, hormonal disturbances, some bone disorders (e.g. achondroplasia), some specific syndromes (e.g. Turner syndrome) and any severe chronic illness can lead to shortness.

What is constitutional delay in growth?

In this condition, the growth rate/ height lag behind the normal range throughout childhood. Parameters like teething, puberty, sexual development and bone age on X-ray are delayed for the comparable age. Yet the final adult height achieved is normal. Usually there is family history of similar growth pattern in a close relative. Parental heights are normal.

What is familial short stature?

Here, both parents are short. Growth rate/ height velocity is lagging behind the normal range but all other parameters are normal. Adult height remains short. This condition is also called Genetic short stature, as in the affected individual the genetic potential for height is less than normal.

What are the hormonal problems causing short stature?

Pituitary is a small gland in brain secreting growth hormone and other important hormones. Hypopituitarism is a condition where pituitary functions below its normal capacity. Hypothyroidism is a condition where thyroid gland in neck is functioning less. Both these conditions cause significant short stature.

Apart from these, untreated / uncontrolled diabetes, excessive steroids (either through medicines or because of adrenal gland dysfunction) and severe vitamin D-resistant rickets can cause shortness.

How do we investigate short stature?

Apart from routine tests of blood and urine done to rule out any significant illness like infection, malignancy or organ dysfunction, specialized tests like X-rays to know bone age, hormonal studies, chromosomal analysis and CT / MRI -scan of brain are often necessary.

In testing for Growth Hormone- related disorders, a single blood level is not informative but rather a series of ‘provocative’ tests using substances that stimulate GH secretion is performed.

How is short stature treated?

Treatment depends on cause of shortness. Correction of underlying systemic illness, malnutrition or psychosocial deprivation is necessary if these are responsible factors.

Familial short stature doesn’t need any treatment. Constitutional delay in growth mostly needs just reassurance. Occasionally some hormonal therapy for sexual development is needed. Pituitary and thyroid hypo-function needs appropriate hormonal replacement.

One important fact to remember about these hormonal treatments –especially using GH- is that they are to be used only with expert advice and are used only when there is a proved deficiency of that hormone in the body.

Believe it or not, tall stature is kind of a social obsession. Regardless of several short people making it big in life, shortness is still looked down upon. (No pun intended!) The emotional support from parents is a must in case of short stature. Such children should be made to realize that height is just a small part of their persona and other positive attributes in their personality would help them overcome this relatively minor physical handicap.

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