When to address childhood growth concerns
When parents or their pediatricians are concerned about a child’s growth, they should seek a consultation. Given that earlier treatment is more likely to be successful, it’s best not to delay seeking those answers.
With the introduction of recombinant human growth hormone, the treatment of childhood growth disorders has evolved significantly. When used appropriately, and closely monitored, the therapy effectively addresses a wide range of growth concerns.
“Growth and development concerns are among the most pressing questions many parents have about their children,” says pediatric endocrinologist Anna Pawlikowska-Haddal, MD, PhD. “They want to know whether or not there is something medically that should be addressed, and whether or not there is anything we can do to promote growth.”
Dr. Pawlikowska-Haddal suggests that when parents or their pediatricians are concerned about a child’s growth, they should seek a consultation. “Those are the types of questions we can answer during an evaluation,” she says. “Given that earlier treatment is more likely to be successful, it’s best not to delay seeking those answers.”
With the advent of biosynthetic growth hormone, “we find that children who have short stature for other specific medical and genetic reasons can respond well to the therapy,” Dr. Pawlikowska-Haddal says.
Childhood growth rates are based on a number of factors, including those family- and gender-associated, and environmental factors such as nutrition. But growth also can be adversely affected by a range of endocrine-related and genetic disorders, as well as for unknown reasons — a condition known as idiopathic short stature.
Children who are referred to UCLA due to concern about abnormal growth are given a comprehensive evaluation to determine the cause, including a physical examination, review of growth patterns over time and, in some cases, blood tests and imaging to investigate hormonal or genetic disorders.
Growth-hormone treatment involves a daily injection. While treatment has proven to be safe for a variety of conditions, it requires careful dosing and monitoring by an expert team. Dosage is based on the child’s weight, growth velocity and, most important, the child’s blood level of insulin-like growth factor-1 (IGF-1). “It’s not only growth hormone but additionally IGF-1 that has a powerful effect on the body, and that is affected by the growth-hormone dose,” says Dr. Pawlikowska-Haddal. “So we monitor the child’s IGF-1 level and adjust the dose to ensure that it is optimal.”
UCLA physicians were instrumental in moving the field from a focus solely on weight and growth velocity to the emphasis on IGF-1 response. That experience is pivotal given the importance of accurate administration and interpretation of the test results, Dr. Pawlikowska-Haddal says. “Growth hormone is an effective drug that can produce wonderful outcomes, but it tends to be overprescribed,” she notes. “It is very important that the child be evaluated by an expert team to ensure appropriate diagnosis and treatment.”
To learn more about the UCLA Growth Disorders Program, visit www.uclahealth.org/pediatricgrowth.