Concerns About Growth Hormone Treatment for Short Stature in Children

Second-grade elementary school student is too short?

Hello doctor, my younger son is in the 2nd grade this year, with a height of 115.5 cm and a weight of 24.5 kg.
I have been observing him for a year, and he has only grown 2.8 cm.
We have done a bone age assessment, and the doctor said he is delayed by 2 years.
Does he need to start growth hormone therapy now? He has atopic dermatitis and needs to take antihistamines daily to sleep well.
Are there any side effects from long-term use? Will it affect his growth?

Fanrao de mama, 0~9 year old female. Ask Date: 2005/01/17

Dr. Liu Jinyong reply Physical Fitness

First, it is important to check whether the serum growth hormone levels are normal.
If they are normal, it is not advisable to administer growth hormone indiscriminately, as this could lead to premature closure of the growth plates, resulting in stunted growth.
Second, antihistamines should not affect growth.

Reply Date: 2005/01/17

More Info

When considering growth hormone (GH) treatment for children with short stature, several factors must be taken into account, including the underlying cause of the short stature, the child's overall health, and potential side effects of the treatment. In your case, your son is currently in the second grade, measuring 115.5 cm and weighing 24.5 kg, which places him below the average height for his age. You mentioned that he has only grown 2.8 cm over the past year and that his bone age is delayed by two years.

Understanding Growth Hormone Treatment
Growth hormone therapy is typically indicated for children diagnosed with growth hormone deficiency or other specific conditions that impair growth, such as Turner syndrome, chronic kidney disease, or Prader-Willi syndrome. Before initiating treatment, it is crucial to confirm that the child has a deficiency in growth hormone through appropriate testing. If the growth hormone levels are normal, administering growth hormone could lead to premature closure of the growth plates, potentially stunting growth rather than promoting it.

Potential Side Effects
Regarding your concerns about side effects, growth hormone therapy is generally well-tolerated, but it can have side effects, including:
1. Injection Site Reactions: Pain, redness, or swelling at the injection site.

2. Headaches: Some children may experience headaches as a side effect.

3. Joint and Muscle Pain: Discomfort in joints or muscles can occur.

4. Increased Risk of Diabetes: Long-term use may affect glucose metabolism, leading to insulin resistance.

5. Fluid Retention: Some children may experience swelling due to fluid retention.

As for the antihistamine medication your son is taking for his atopic dermatitis (eczema), long-term use can have side effects, including drowsiness, dry mouth, and potential impacts on growth if used excessively. However, when used as prescribed, it is unlikely to significantly affect his growth.

Recommendations
1. Consult a Pediatric Endocrinologist: It is essential to have a thorough evaluation by a pediatric endocrinologist. They can assess your son’s growth pattern, conduct necessary hormone tests, and determine if he is a suitable candidate for growth hormone therapy.

2. Monitor Growth Regularly: Keep track of your son’s height and weight over time. Regular monitoring can help identify any significant changes or patterns in growth.

3. Evaluate Nutritional Status: Ensure that your son is receiving a balanced diet rich in essential nutrients that support growth. Adequate protein, vitamins, and minerals are crucial for healthy development.

4. Consider Psychological Factors: Height can be a sensitive issue for children. It’s important to provide emotional support and reassurance, regardless of growth outcomes.

5. Discuss All Medications: Make sure to discuss all medications your son is taking with his healthcare provider to ensure there are no interactions or compounded side effects.

Conclusion
In summary, while growth hormone treatment can be beneficial for children with specific deficiencies, it is vital to have a comprehensive evaluation to determine if it is appropriate for your son. The potential benefits must be weighed against the risks and side effects. Consulting with a specialist will provide the best course of action tailored to your son’s individual needs.

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