Patient's question:
My child is over 11 years old this year and is much shorter than other children of the same age. He is not focused in class, careless with homework, and especially loves playing. His penis is also small. He has been checked at a children's hospital, but no illness was found. Please ask what can help him grow taller. Thank you!Doctor's answer:
First Category: Idiopathic Short Stature1. Familial Short Stature: The cause of short stature in this type of child comes from their parents. Generally, a child's height is related to the average height of their parents. If the parents are particularly short and hope their child grows as tall as a tree, it is of course an impossible task. In summary, children of this type are completely normal except for their height, so their bone age is equal to their actual age. Before puberty, they can grow 4 to 5 cm per year; after puberty, they can grow 7 to 10 cm per year. The age at which they enter puberty is no different from that of other children.
2. Constitutional Growth Delay: Children of this type not only have short stature but are often accompanied by delayed puberty. Since this is a constitutional issue, it is unrelated to the genetics of their parents, so their parents' average height is normal. In summary, the majority of patients in the clinic fall into this category. These children are of the "late bloomer" type. Although their growth rate is slightly slower each year, they are always seated in the front row at school. However, due to their delayed puberty, their bone age lags behind their actual age. Gradually, they catch up each year. When most people have completed their puberty and their growth plates have fused, these children are still in their puberty and continue to grow, so their final height is no different from that of average adults.
Second Category: Endocrine Short Stature
Endocrine short stature is usually related to chromosomal abnormal mutations. A few have already identified the genes causing the mutations, while the majority still lack specific gene mutation syndromes and are named after the discoverer's gender.
1. Specific Chromosomal Abnormalities:
(1) Turner Syndrome [Turner syndrome]: Sex chromosome abnormality, commonly 45XO.
(2) Down Syndrome [Down syndrome]: An extra chromosome in the 23rd pair [23 trisomy].
2. Non-Specific Chromosomal Abnormalities:
(1) Noonan Syndrome [Noonan syndrome].
(2) Prader-Willi Syndrome [Prader-Willi syndrome].
3. Intrauterine Growth Retardation: Children of this type exhibit growth retardation during the prenatal stage due to various causes, such as maternal malnutrition, iron-deficiency anemia, intrauterine infection with pathogenic microorganisms, taking special medications, or fetal genetic defects leading to abnormal development. Since the nutrition of the fetus during this stage is closely related to its later development, even simple malnutrition is difficult to compensate for after birth. Cases with significantly low intelligence are also quite common.
4. Skeletal Development Abnormalities: Children of this type have an uneven upper-to-lower body proportion. Generally, this can be divided into cartilage development abnormalities or long bone development abnormalities, etc.
5. Metabolic Product Accumulation: Due to a lack of certain key enzymes in the body, children of this type cannot have normal metabolism, leading to the accumulation of metabolic products throughout the body. Examples include children with mucopolysaccharidosis.
Third Category: Exogenous Short Stature
1. Specific Organ System Diseases: Examples include allergic rhinitis, asthma, encephalitis, congenital heart disease, nephritis, hepatitis, parasitic infections, benign or malignant tumors, etc. The growth curve of children with this type of condition shows a clear deviation, usually traceable back to the age of their initial illness. If the underlying disease is curable, height often catches up to normal levels after treatment [catch-up growth].
2. Endocrine Disorders: Children with endocrine abnormalities must undergo a thorough evaluation to rule out the possibility of tumors. Multiple endocrine abnormalities may require a magnetic resonance imaging (MRI) scan of the pituitary gland, as pituitary tumors can be as small as a few millimeters. It is necessary to go to a well-equipped hospital for this examination. Common endocrine disorders that cause short stature include:
(1) Hypothyroidism [Hypothyroidism].
(2) Growth Hormone Deficiency [Growth hormone deficiency].
(3) Pseudohypoparathyroidism [Pseudohypoparathyroidism].
(4) Cushing Syndrome [Cushing syndrome].
3. Psychosocial Short Stature: Long-term psychological trauma caused by a poor family environment, similar to physical illness, can also affect growth and development. Children of this type have no abnormalities in their physical examinations but show a deviation in their growth curve. If detected early, efforts can be made to isolate abused children in a normal environment for growth. After long-term psychological counseling and rehabilitation, their height often catches up to normal levels.