Growth Issues in Boys: Height Concerns and Treatment Options

Children not growing taller?

Hello, doctor.
I would like to ask about my son, who has consistently been in the 3rd percentile for height since the second grade.
He is now almost 13 years old, standing at 150 cm and weighing 58 kg.
Over the past three years, we have been tracking his bone age.
In the first two years, his bone age was approximately 2-3 years younger than his actual age.
However, six months ago, his bone age rapidly increased to 13 years (actual age 12.5 years), and the most recent measurement showed a bone age of 15 years (actual age 13 years).
It is estimated that he may not exceed 160 cm in height.
Over the past year, he has grown about 9 cm, and in the last six months, there has been a noticeable increase in genital size, he has started developing pubic hair, and his voice has begun to deepen.
The doctor suggested considering a three-month injection of Leuprolide, and I should research the information myself.
I have looked into related discussions but still do not fully understand it and feel quite anxious.
Given the high cost, which is a significant burden, I would like to ask about my son's current situation: if we do not proceed with the injection and instead focus on diet, exercise, and sleep, how much longer might the growth plates remain open for him to continue growing? Is it possible for him to grow more than 15 cm? Or, considering the current situation, is self-funded Leuprolide injection the best option for height increase? Is Leuprolide effective for boys' growth (I have read online that it may not work well for boys and that it is better to administer it before the bone age reaches 13, but his current bone age is already 15)? While Leuprolide suppresses puberty development, could it also lead to a significant decrease in growth rate, potentially negatively impacting the child's growth? I found that Leuprolide is typically administered once a month; what is the injection given every three months, and is its effectiveness better?

Xiao Mantou Mama, 40~49 year old female. Ask Date: 2016/07/04

Dr. Shi Guozheng reply Orthopedics

The use of this medication must be prescribed by a pediatrician or a specialist in metabolic disorders.
Leuprorelin is an LH-RH analog that can be used to treat central precocious puberty.
Please consult the aforementioned specialists for inquiries.

Reply Date: 2016/07/04

More Info

When it comes to growth issues in boys, particularly regarding height concerns, it is essential to consider a variety of factors that can influence growth patterns. In your case, your son is currently 13 years old, with a height of 150 cm, which places him in the lower percentile for his age group. His rapid bone age advancement and the physical changes associated with puberty indicate that he is entering a critical period of growth.

Understanding Growth and Bone Age
Bone age is a crucial indicator of growth potential. It reflects the maturity of a child's bones and can provide insight into how much growth is left. In your son's case, his bone age has progressed to 15 years, while his chronological age is only 13. This discrepancy suggests that he may have a limited growth window left, as growth plates typically close after puberty. For boys, this process usually occurs between the ages of 16 and 18, but it can vary significantly.

Factors Influencing Growth
Several factors can influence a child's growth, including genetics, nutrition, physical activity, and hormonal levels. Given that your son has a robust build and is experiencing signs of puberty, it is likely that he is undergoing significant hormonal changes that can impact his growth trajectory.
1. Genetics: Family history plays a significant role in determining height. If both parents are of average or above-average height, there may be a genetic predisposition for your son to grow taller, even if he is currently below the expected height for his age.

2. Nutrition: A balanced diet rich in essential nutrients, particularly calcium and vitamin D, is vital for bone health and growth. Ensuring that your son consumes adequate amounts of protein, fruits, vegetables, and whole grains can support his growth.

3. Physical Activity: Regular exercise, especially activities that promote strength and flexibility, can positively influence growth. Sports like basketball or swimming can be beneficial.

4. Sleep: Adequate sleep is crucial for growth hormone secretion. Adolescents typically require more sleep than adults, and ensuring your son has a consistent sleep schedule can help maximize his growth potential.

Treatment Options
Regarding the use of Leuprolide (often referred to as Lupron), it is a medication that can be used to suppress premature puberty in boys. The goal of this treatment is to delay the onset of puberty, which may allow for additional growth before the growth plates close. However, the decision to use this medication should be made with careful consideration and consultation with a pediatric endocrinologist.

1. Effectiveness: Leuprolide can be effective in managing growth issues related to precocious puberty. However, its effectiveness can vary from individual to individual. The timing of administration is crucial; it is generally more effective when started before significant pubertal changes occur.

2. Potential Side Effects: While Leuprolide can help delay puberty, it may also lead to a decrease in growth velocity during treatment. This is a critical consideration, as it could potentially offset the benefits of delaying puberty.

3. Cost and Commitment: The financial burden of such treatments can be significant, and it is essential to weigh the potential benefits against the costs. If you decide to pursue this option, ensure that you have a clear understanding of the treatment plan and its implications.

Conclusion
In summary, while your son may have limited growth potential given his current bone age, there are still avenues to explore. A combination of proper nutrition, regular exercise, and adequate sleep can support his growth. If you are considering medical intervention, such as Leuprolide, it is crucial to consult with a pediatric endocrinologist who can provide personalized advice based on your son's specific circumstances. Ultimately, the decision should be made with a comprehensive understanding of the potential benefits and risks involved.

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