Growth begins when a baby is conceived in the womb. It is a complex process, influenced by a variety of factors that are still being unraveled. While there are some children who start life smaller than others, most of them usually catch up very early in life. However, for those children who are still significantly shorter by age 2 — below the third percentile on standard growth charts — they will most likely not catch up later in life and will probably remain much shorter than other children their age, and continue to be short as adults. These children have a lifelong growth disorder called “small for gestational age”, or SGA. In the U.S., 3 percent of all babies are born SGA every year. While the majority catch up to normal height by age 2, as many as 10 percent, or about 12,000 annually, do not. As a result, there are as many as 150,000 unique children over the age of 2 who are under-height and, if left untreated, may never reach their growth potential. And while the size of a young child with SGA may be considered cute, especially among girls, there is nothing cute about the challenges they face as they get older. New parents can help by working with their pediatrician to pay close attention to growth charts and detect whether there is an underlying medical problem. Since SGA is relatively rare, many parents are unfamiliar with the disorder and don’t know where to turn for help. Elizabeth and Gary Basso of Putnam County had many questions, but no answers about their child’s slow growth. The Bassos’ second oldest son, Eric, was a full-term baby, but was considerably small at birth, weighing just four pounds, 13 ounces, and measuring less than 18 inches. As an infant, the Bassos could tell he wasn’t growing at a normal rate. They became increasingly concerned and had Eric tested numerous times to find out what was wrong, but the results revealed nothing. By age 4, Eric was shorter than 97 percent of children his age. For a period of time, people even assumed Eric and his little brother, who is two years younger, were twins. When the Bassos finally visited my office, I discovered that Eric suffered from SGA. Although he was producing sufficient growth hormone, he was not growing at a normal rate and never achieved “catch up” growth. Eric began daily injections of a growth hormone called Genotropin, which is the first and only FDA-approved growth hormone for the treatment of SGA. Eric experienced no major side effects from treatment with growth hormone, the most common being injection site reactions and eczema. Since he began treatment, Eric has grown approximately four inches a year and has caught up in size to his classmates.
Understanding SGA Caused by a complication or trauma during pregnancy, it is believed that children with SGA have a difficult time processing growth hormone, which is naturally occurring in the body, and therefore need additional growth hormone to overcome the resistance and achieve normal height. If your child was born small (under 5.6 pounds and 18 inches for full-term babies) and does not seem to be catching up, you should talk to your pediatrician to determine whether visiting a specialist is necessary. The earlier medical supervision and treatment occurs, the better off your child will be —for two key reasons: The first is that studies have shown kids with SGA can have significant academic and social problems, including being left back in school, shyness and low self-esteem. Therefore, experts believe if treatment begins prior to children beginning school, there is a greater chance that their height may begin to normalize and these consequences may be reduced. The second reason for early diagnosis and treatment is that the majority of growth occurs before puberty. Therefore, the older a child is before beginning treatment, the less time he or she has to accelerate their growth and catch up to normal height — before they stop growing all together (usually in their mid-teens for girls and late teens for boys). For additional information about SGA and Genotropin, visit www.genotropin.com. For information about other childhood growth disorders contact The Magic Foundation at www.magicfoundation.org, or call (708) 383-0808.
To determine whether your child might have a growth disorder, take this quick test:
_ Was your baby full term, but less than 5.6 pounds or 18 inches when he/she was born? _ Do people typically think your child is younger than he/she is? _ Is your child the smallest in his/her playgroup? _ If your physician regularly measures height/weight, is your child below the third percentile?
If these questions raise concerns about your child’s growth, talk to your doctor and he or she will determine whether your child needs to be evaluated by a pediatric endocrinologist, a specialist in children’s metabolic and growth disorders.
PAUL SAENGER, M.D., a pediatric endocrinologist, is an attending physician and professor of pediatrics at The Children’s Hospital at Montefiore Medical Center and Albert Einstein College of Medicine.