Conditions
Pediatric endocrinology: height, skeletal age and puberty
Short answer
Short stature in children can be treated with early intervention.
- If a child older than 4 gains less than 4 cm in height per year, that is already a warning sign.
- If the annual gain is 6 cm or more, there is usually no serious problem.
A child's bone age is determined with an X-ray of the left wrist and compared with biological age. Hormone tests, however, should be done only when there is a complaint. It is not right to prescribe a hormonal medication for every “abnormal” number.
For children over 4.
General information
- Monitoring height growth. The doctor usually follows the patient at three-month intervals. If there is growth of 1.5–2 cm in three months, there is no reason for concern. The growth norm is different at each age; the figure of 4 cm/year is taken as the basis for children older than 4. Parents often notice the problem themselves: the child is among the shortest in the class or lags behind peers.
- Skeletal age (left wrist X-ray). It is important in these cases:
- suspected delayed or early puberty;
- delayed growth in height;
- diagnosis of hormonal problems (growth hormone deficiency, early puberty, etc.).
The result is compared with the child's actual age and height potential. The doctor emphasizes: “In every case, the X-ray must be taken and evaluated under a doctor's supervision.”
- Caution with hormonal medications. When examining children, it is not right to order tests straight away: hormones should be checked when there is a complaint or concern. For example, sex hormones are expected to be low in an 8-year-old child, and it is not right to prescribe a hormonal medication after looking at these numbers. Unnecessary hormonal medications can close the growth zones of the bones early and cause short stature later on.
- Growth hormone disorders. For information about deficiency and gigantism → Acromegaly and growth hormone.
- Thyroid nodules in children. In children, regardless of sex, thyroid nodules should be approached with more care.
- Obesity in children. Some weight-loss injections (GLP-1 agonists) are indicated for use in children over 12 whose BMI is above the 95th percentile for age. The doctor makes the decision (video).
In the doctor's practice
- In a girl with signs of early sexual development, a hand X-ray put the bone age at about 11 years, whereas her biological age was 9.4. Appropriate examination and treatment were planned.
- In a boy born in 2017 (8 years old), sexual development was appropriate for his age. Based on the tests, no hormonal medication was prescribed, the parents were given advice, and the next follow-up was planned.
- According to the OTX interview, short stature in children is one of the problems the doctor encounters most often in the Ganjabasar region.
Q&A
My child's hormone tests differ from the norm. Is medication needed?
Not every number means medication. In a child, hormones should be checked only when there is a complaint. It is not right to prescribe a hormonal medication by looking at a result that is normal for the child's age, because this can cause short stature later on.
When is a hand X-ray (skeletal age) needed?
When height growth slows, when early or delayed puberty is suspected, and when a growth hormone disorder is considered. The X-ray should be ordered and evaluated by a doctor.