Growth Delays in Children: A Pediatric Perspective

Growth issues in children?

Hello Dr.
Wang,
My daughter was born weighing 3850 grams (75th percentile), measuring 53 cm in length (75th percentile), and with a head circumference of 36.5 cm (90th percentile).
She started experiencing chronic constipation around one month old, which only improved when she was nearly two years old.
There are no issues such as intussusception in her colon; she simply has slow gastrointestinal motility.
At two months old, her growth was at its best, with her head circumference, weight, and height all tracking along the same percentile line as at birth.
However, after two months, her percentiles began to drop, with only her head circumference remaining at the 75th percentile.
By around 18 months, her weight was just slightly above the 3rd percentile, and it wasn't until she was three and a half years old that it rose to the 10th percentile, where it remains now at three years and nine months (weight 13 kg, height 95 cm).
Her height has consistently remained at the 10th percentile since she was one year old.
Despite having a normal diet, I am unsure why she is smaller than her peers.
When she stands next to her younger brother, who is one and a half years younger, people often mistake them for twins.
Is this considered growth delay? I am concerned about missing any necessary treatment, as both the health department doctors and those at Changhua Christian Hospital have been unwilling to answer my questions.
If further examinations are needed, could you please recommend reliable hospitals and doctors in central Taiwan?
Additionally, my son started teething only after he was 14 months old, and it wasn't until he was 26 months old that he had a full set of 16 teeth.
Is this a cause for concern? Both of my children have no abnormalities in their diet or activity levels.
I hope you can help clarify these issues.
Thank you.

Fanrao de mama, 30~39 year old female. Ask Date: 2007/07/30

Dr. Wang Jiayi reply Pediatrics

Dear Concerned Mother,
Please do not worry too much! If your child's teeth are developing normally, there is no need for excessive concern.
Currently, your child's weight is in the 10th percentile and height is between the 10th and 25th percentiles, which falls within the normal range.
It's important to note that bigger is not always better for children! Excessive worry can inadvertently place significant psychological pressure on your child, which can be detrimental to their growth.
You may consider visiting Dr.
Fu Ling-Hsien at Taichung Veterans General Hospital's Pediatric Department, but other major medical centers in central Taiwan also maintain a high standard of care.
Hualien Hospital's Pediatrics Department is here to support you!

Reply Date: 2007/07/30

More Info

Understanding growth delays in children is a multifaceted issue that requires careful evaluation of various factors, including genetics, nutrition, and overall health. Based on the information you've provided about your daughter, it appears that she has experienced some growth concerns, particularly in terms of weight and height percentiles.
At birth, your daughter was in the 75th percentile for both weight and length, which is considered a healthy range. However, the decline in her growth percentiles after two months, particularly her weight dropping to the 3rd percentile and height remaining around the 10th percentile, raises valid concerns about potential growth delays. Growth percentiles are important indicators of a child's growth trajectory, and significant drops can signal underlying health issues.

The fact that your daughter experienced prolonged constipation until the age of two could have contributed to her growth issues. Chronic constipation can lead to discomfort and may affect a child's appetite and nutritional intake, which are crucial for growth. While her dietary intake appears normal, it may be beneficial to assess her overall nutritional status, including macro and micronutrient intake, to ensure she is receiving adequate nutrition for her growth needs.

In terms of growth delay, it is essential to differentiate between constitutional growth delay (a normal variation of growth patterns) and pathological growth delay (which may indicate underlying health issues). Given that your daughter is currently at the 10th percentile for height and weight, it would be advisable to consult with a pediatric endocrinologist. They can conduct a thorough evaluation, which may include growth hormone testing, bone age assessment through X-rays, and other relevant tests to determine if there are any hormonal or metabolic issues affecting her growth.

Regarding your son, the delayed eruption of teeth is not uncommon and can vary significantly among children. While most children begin to develop teeth around six months, some may start later without any underlying health issues. If he is otherwise healthy and meeting developmental milestones, this may not be a cause for concern.

In summary, it is crucial to seek a comprehensive evaluation from a pediatric specialist who can provide insights into your daughter's growth patterns and any necessary interventions. Early intervention is key in addressing growth delays, and a specialist can guide you on the appropriate steps to take. Additionally, maintaining a supportive environment that encourages healthy eating and physical activity can positively influence your children's growth and development.
If you are looking for reliable hospitals and specialists in central Taiwan, consider reaching out to Taichung Veterans General Hospital or National Taiwan University Hospital, which are known for their pediatric departments. They can provide the necessary assessments and recommendations tailored to your children's needs.

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