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Parents often ask about using growth hormone for their short kids to help them get a little taller. And most of the time, they are going to be told that their child is short, but growing normally, and doesn't need growth hormone treatment.
While growth hormone or Humatrope (Somatropin) can help some short children, its use has usually been restricted to kids with growth hormone deficiency, Prader Willi Syndrome, and Turner Syndrome.
This left out a lot of short kids who, if they aren't treated, are going to be short adults.
Recently, the indications for which kids can be treated with growth hormone has been expanded. Growth hormone can now be used for the long-term treatment of children with idiopathic (of unknown origin) short stature, also called non-growth hormone deficient short stature, who are more than 2.25 SD below the mean for age and sex, or the shortest 1.2% of children. For example, according to the FDA, for 10-year old boys and girls, this would correspond to heights of less than 4' 1" inch. This would further correspond to heights of less than 5' 3" and 4' 11" in adult men and women, respectively.
Some new studies and reports have recently shown that another group of these short kids, those who were born Small for Gestational Age (SGA), may also benefit from treatment with human growth hormone.
Newborns who are considered to be SGA are born with a weight and/or height that is below the 3rd percentile on fetal growth charts. For example:
- a 25 week premature baby who is born weighing less 600g and/or less than 31cm in length
- a 28 week premature baby who is born weighing less 800g and/or less than 34cm in length
- a 33 week premature baby who is born weighing less 1400g and/or less than 40cm in length
- a 36 week premature baby who is born weighing less 2000g and/or less than 43cm in length
- a 40 week premature baby who is born weighing less 2600g and/or less than 46cm in length
Most of these babies born SGA will eventually catch-up in their growth and will end up above the 3rd percentile on growth charts by 6 months of age. However, about 10% of SGA infants will remain below the 3rd percentile and will not catch-up.
The International Small for Gestational Advisory Board has recommended that if 'a short child who was born SGA has not caught up by age 2 to 3 years of age and whose catch-up growth has stopped should be referred to a pediatrician who has expertise in endocrinology.'
At this age, once other causes of short stature have been excluded, treatment with growth hormone can be considered with a goal of 'catch-up growth in early childhood, maintenance of normal growth in childhood, and achievement of normal adult height.'
What are the downsides? Besides being expensive, growth hormone treatment consists of 6-7 injections each week.
Still, since growth hormone treatment is 'effective and safe' and the benefit of avoiding 'potential long-term adverse outcomes of SGA birth' such as 'peer-group alienation, low self-esteem, impaired social dynamics, behavioral problems, and lower educational achievement and professional success, together with failure to achieve catch-up growth provide a rationale for treating short children who are born SGA with growth hormone.'
References:
International Small for Gestational Age Advisory Board consensus development conference statement: management of short children born small for gestational age, April 24-October 1, 2001.
Lee PA - Pediatrics - 01-JUN-2003; 111(6 Pt 1): 1253-61
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