Human growth hormone (HGH), produced by the pituitary glands, controls a child’s body growth and plays a vital role in increasing muscle mass and decreasing body fat. The body’s growth hormone levels increase during childhood, peak during puberty, and decline after the third decade of life (1) (2).
Children with growth hormone deficiency (GHD) may have a short stature, growth failure, and delayed skeletal maturation. This condition can be treated by injecting artificial growth hormone.
Read this post to know all about growth hormone deficiency in children.
Symptoms Of Growth Hormone Deficiency (GHD) In Children
It is necessary to observe and track your child’s growth to diagnose GHD early on. As children grow at different rates, it is not easy to identify the symptoms of GHD in children. Here are some common symptoms of GHD that might help you take the necessary steps (3) (4).
- Stunted or slowed growth after the age of three
- Younger-looking face
- Chubby body build
- Prominent forehead
- Underdeveloped bridge of the nose
- Delayed puberty
These symptoms may also appear in other conditions. Thus, always consult your child’s physician for the right diagnosis.
What Causes Growth Hormone Deficiency In Children?
The causes of GHD can be grouped under congenital and acquired.
Congenital causes of GHD
These causes could result from mutations in genes or malformation of the pituitary gland and the hypothalamus before birth. Some congenital causes for GHD are (4)
- Turner syndrome
This is a genetic disorder that affects females. In this condition, the child is born without one X chromosome. Girls with Turner syndrome often have a short stature, as they are born with intrauterine growth retardation. They fail to grow during early childhood, and this further worsens during puberty, resulting in a height shorter by approximately 20cm than that of the average population (5). The growth retardation in children with Turner syndrome is not due to the lack of growth hormone in the pituitary gland but due to the body’s inability to use it (6).
- Prader-Willi Syndrome
The Prader-Willi syndrome is a genetic condition caused by the loss of the parental copy of a gene in chromosome 15 (7). It is characterized by decreased muscle tone, poor sucking, and feeding difficulties in early infancy. Children with this syndrome have developmental delays and may become morbidly obese if their diet is not monitored (8).
- Small for gestational age
Children born small for gestational age (SGA) generally continue to experience growth retardation into adulthood. SGA is due to abnormal growth hormone secretion and abnormal insulin-like growth factor levels (9).
- Primary growth hormone insensitivity (GHI)
Also known as Laron syndrome, this is a condition where the body is unable to use the growth hormone. GHI is a rare genetic disorder and is caused due to mutations in the growth hormone receptor gene. It is characterized by low or high levels of circulating growth hormone, delayed bone age, delayed onset of puberty, prominent forehead, and low blood sugar (10). Growth hormone therapy may not be effective for this syndrome, as the body is not able to use the growth hormone.
Causes of acquired GHD
Some common causes of acquired GHD include
- A tumor in the hypothalamus or pituitary
- Head injury
- Radiation therapy for cancers in the head
- Diseases or infections of the pituitary or hypothalamus glands
- Autoimmune conditions
- Decreased nutritional intake
- Gastrointestinal disorders
- Hypothyroidism (4).
Risks And Complications Of GHD
Children born into families with a history of genetic disorders, children who had a brain injury or tumor, and children undergoing radiation therapy are at a greater risk of developing GHD.
Growth hormone deficiency can result in complications such as decreased bone mineral density, increased cardiovascular risk factors, and decreased energy level (4).
Diagnosis Of Growth Hormone Deficiency
Growth increments are one of the primary and early criteria for the diagnosis of GHD. The growth rates of normal children are given below.
First six months: 16 to 17cm
Second six months: 8cm
Second-year: 10cm or more
Third-year: 8cm or more
Four to ten years: 5 to 6cm
A 10% decrease in these growth rates could indicate a defect in height velocity (10).
Your child’s doctor might enquire about your child’s medical history and your family history. They may prescribe the following tests to understand the underlying cause (11).
- Radiographic assessment of bone age
- Measurement of insulin-like growth factor 1
- Measurement of IGF binding protein 3
- Provocative growth hormone testing
- Cranial MRI
Treatment For GHD In Children
The standard treatment for GHD in children is the injection of synthetic growth hormone. Children should be started on recombinant growth hormone replacement as soon as GHD is diagnosed.
Your doctor would start the dosage and gradually increase it to the highest level by the time the child hits puberty (10). The injection is given subcutaneously into the fatty layer of tissue and is relatively safe and effective.
What To Expect From The Treatment?
One of the major signs you might notice is growth. It may take three to six months to see the growth; your child might grow one to two inches in the first six months. You may also notice
- Foot growth within six to eight weeks, and your child may outgrow their shoes quickly.
- An increase in appetite.
- An increase in lean body mass. Thus, your child might look slimmer with the growth hormone treatment.
This treatment is long-term and might continue until your child reaches their full growth potential. Visiting the endocrinologist regularly and monitoring the growth through blood tests and X-rays are mandatory. Although the duration of the treatment may vary from child to child, you need to continue the treatment until the child
- Reaches the full adult height.
- Attains full bone maturity.
- Grows less than two centimeters in the last year.
Possible Side Effects Of The Treatment
Growth hormone treatment is safe and effective for children. However, there might be some side effects, such as
- Allergic reaction near the injection site
- Increase in the spine curvature in children with scoliosis
- Increase in blood sugar levels when the treatment is stopped.
If the side effects persist, it is best to call your doctor (12).
How Can You Help Your Child With GHD?
Along with the doctor’s treatment, you can help your child deal with growth hormone deficiency by following the tips given below.
- Exercise regularly
Encourage your child to do adequate physical activity in a day. Studies suggest that aerobic and resistance exercises increase growth hormone production (13). Exercising might also help in reducing belly fat.
2. Reduce sugar intake
Growth hormone therapy causes a temporary increase in blood sugar. It is important to instruct your children to stay away from carbohydrates and candies. Design your child’s diet plan and make sure they have nutritious food.
3. Have adequate sleep
Create a bedtime routine and encourage your child to stick to it. Adequate sleep is necessary for the production of growth hormones (14).
Often families are concerned with growth hormone deficiency if their child is smaller than other children their age. It is important to take a thorough family history and to look at the height velocity. Kids with a consistent decrease in height velocity should be evaluated by the endocrinologist as soon as possible for maximum intervention.
2. Jose M Garcia et al.; Growth Hormone in Aging; Endotext
3. Growth Hormone Deficiency in Children; Cedars Sinai
4. Growth Hormone Deficiency Symptoms & Causes; Boston Children’s hospital
5. Bessie E Spiliotis; Recombinant human growth hormone in the treatment of Turner syndrome; Dovepress
6. Growth; Turner syndrome foundation
7. Nicola Bridges; What is the value of growth hormone therapy in Prader Willi syndrome?; British Medical Journal
8. Zehra Aycan, and Veysel Nijat Baş; Prader-Willi syndrome and growth hormone deficiency; PubMed
9. Chatelain P et al.; Growth Hormone Therapy for Short Children Born Small for Gestational Age; PubMed
10. Growth Hormone Deficiency; National Organization for Rare Disorders
11. Takara Stanley; Diagnosis of Growth Hormone Deficiency in Childhood; HHS Manuscript
12. Growth Hormone Treatment; UPMC Children’s Hospital of Pittsburgh
13. Laurie Wideman et al.; Growth hormone release during acute and chronic aerobic and resistance exercise: recent findings; PubMed
14. J R Davidson, H Moldofsky, and F A Lue; Growth hormone and cortisol secretion in relation to sleep and wakefulness; Journal of Psychiatry and Neuroscience