Growth Issues in Adolescents: A Case Study on Bone Age

Developmental issues

Hello, my son is almost 14 years old and is on the shorter side.
He has been monitored for bone age, and his left hand has consistently shown a delay of about a year.
Last year, he experienced a sudden growth spurt, and during a follow-up in August, his bone age matched his actual age, and he grew 12 centimeters.
When we returned for another follow-up in April this year, his bone age had advanced to 15 years, leaving him with only one year of growth potential, which means he has grown two years' worth of bone age in just eight months—almost three times the normal rate.
My son is currently only 156 cm tall.
I'm unsure why this is happening (he has already entered puberty).
Are there any remedial measures we can take? Thank you.

Ku Nao Ba Ba, 40~49 year old female. Ask Date: 2021/04/29

Dr. Chen Bochen reply Orthopedics

1.
Bone age is a reference point and should not be a cause for excessive concern.

2.
There are three main factors that are most closely related to height increase based on medical evidence:
a.
Genetic factors: This is something that cannot be changed.

b.
Sleep duration: The more you sleep, the taller you grow.
Avoid watching TV, using computers, or engaging with electronic devices two hours before bedtime, as blue light can disrupt sleep and hinder development.

c.
Sugary beverages and processed foods: The more junk food and sugary drinks consumed, the less likely one is to grow taller.
It is better to eat whole, unprocessed foods.

3.
There are two secondary factors:
a.
Exercise: During the growth period, it is important to engage in running, jumping, and getting plenty of sunlight.

b.
Nutrition: Drink plenty of milk and avoid picky eating.
Instead of spending a lot of money on commercial growth supplements like calcium, collagen, or other products, it is more effective and cost-efficient to focus on the five points mentioned above, which are supported by medical evidence.

Reply Date: 2021/04/29

More Info

Understanding growth issues in adolescents, particularly in relation to bone age, is crucial for parents and healthcare providers. Your son’s case illustrates the complexities of growth patterns during puberty, and it raises important questions about how bone age relates to actual height potential.

Bone age is a measure of skeletal maturity, which can be assessed through X-rays of the left hand and wrist. It reflects the development of bones and can differ from chronological age. In your son’s case, it appears that his bone age has accelerated significantly, which is not uncommon during puberty. Typically, boys experience a growth spurt during puberty, which can lead to rapid increases in height. However, if the bone age is advancing faster than chronological age, it may indicate that the growth plates (epiphyseal plates) are maturing more quickly, potentially leading to an earlier closure of these plates.

The fact that your son experienced a significant height increase of 12 cm in one year is a positive sign, indicating that he is undergoing the growth spurts typical of puberty. However, the subsequent assessment showing a bone age of 15 years at just under 14 years of age raises concerns. This suggests that he may have limited time left for further growth, as most boys complete their growth by around 16 to 18 years of age when the growth plates close.

In terms of potential remedies or interventions, it’s essential to focus on a few key areas:
1. Nutrition: Ensure that your son is receiving a balanced diet rich in essential nutrients, particularly calcium and vitamin D, which are crucial for bone health. The recommended daily intake of calcium for adolescents is about 1,200 mg. Foods such as dairy products, leafy greens, and fortified foods can help meet these needs.

2. Physical Activity: Encourage regular physical activity, particularly weight-bearing exercises, which can promote bone health and overall growth. Activities like running, jumping, and sports can stimulate growth hormone production.

3. Sleep: Adequate sleep is vital during adolescence, as growth hormone is primarily secreted during deep sleep. Ensure that your son is getting enough rest, ideally 8-10 hours per night.

4. Medical Consultation: Since your son is already in puberty and has experienced rapid changes in bone age, it would be prudent to continue consulting with a pediatric endocrinologist. They can provide insights into whether any hormonal evaluations or treatments are necessary. In some cases, medications may be considered to help manage growth patterns, but this would require careful evaluation by a specialist.

5. Monitoring Growth: Regular follow-ups to monitor both height and bone age are essential. This will help track any further changes and provide a clearer picture of his growth potential.

In conclusion, while your son’s rapid increase in bone age is concerning, it’s important to remember that growth patterns can vary widely among adolescents. With proper nutrition, physical activity, and medical guidance, there may still be opportunities to maximize his growth potential. Engaging with healthcare professionals who specialize in adolescent growth can provide tailored strategies to support your son during this critical developmental period.

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