When children are too short or tall for their age, the reason can’t always be attributed to heredity or hormones. There may be other health problems that need to be addressed, says Hema Vijay

Should a parent be concerned when a child is exceedingly short or tall in comparison to other kids of the same age and gender?

Adequate nutrition, exercise and sleep help most children reach their optimum height. But in some children, their short stature may be an external indication of some diseases even several months/years before the symptoms show up. So, keeping track of a child’s growth can help identify the underlying disease which is preventing this development.

Of course, kids experience a growth spurt at various stages of their adolescent years, making kids of the same age differ vastly in height. Growth is also a highly variable factor linked to heredity, making it difficult for laypersons to interpret if a child’s growth is on the right track or not.

But, when a child is exceedingly short or tall, it is prudent to investigate the cause for it, rather than assuming that growth will occur later, or dismissing a lack of growth on the premise that others in the family too are not tall. Much like pulse and blood pressure statistics in adults, growth in children is an important indicator of health.

Systemic disorders

For instance, it took a thorough investigation to discover that Lavanya’s abnormally short stature compared to others of her age and gender was due to her malfunctioning kidneys, though no symptom of this was apparent. “In fact, a wide range of systemic disorders — cardiac, liver, intestinal, genetic, hormonal, asthma and even psycho-social stress — could manifest themselves in the form of stunted growth. Likewise, heredity or hormonal reasons could result in a child growing exceedingly tall. Irregular growth because of underlying diseases occurs in around 10-15 per cent of children,” says senior consultant endocrinologist Dr. Shriraam Mahadevan.

Growth chart

While parents and paediatricians do keep track of a child’s weight, height is often ignored. The American Academy of Pediatrics recommends that both the height and weight of a child should be measured at birth, age 2-4 days, 1, 2, 4, 6, 9, 12, 15, 18 and 24 months, and every year thereafter till age 21. A child’s growth rate over the years is as crucial as its current height. Plotting a child's height on a growth chart specific to its age, gender, ethnicity and country will help paediatricians to evaluate if the child is on the right growth track and, if not, prescribe tests to identify and address the underlying health issue. Hence, just as academic records are preserved, parents should also maintain a record of their child’s growth over the years.

Early diagnosis

The good news is that when its health problems are sorted out, the child catches up to reach the desired height for its age. Early diagnosis works best, as children gain height only after their bones fuse, and this ceases only after they complete puberty. “More often it is girls of unusually low height rather than boys who seek medical help very late. If these kids’ growth path had been investigated earlier, better results could have been achieved. Many parents ignore a lack of growth because of the misconception that all girls grow till age 18 and boys till age 21,” says paediatrician Dr. Meena Raghavan. Puberty generally begins between ages eight-and-a-half and 13 in girls and nine-and-a-half and 13-and-a-half in boys.

Gaining height

A normal, healthy child with no nutritional deficiency or systemic health problem will usually reach a height ranging up to plus or minus 6.5 centimetres (for boys and girls respectively) of the average of his/her parents’ height, assuming that the parents too had reached their optimum height. And remember, it is not just the genes inherited from tall parents, adequate physical exercise and nutrition also play a key role in a child’s vertical growth. Adequate sleep is also essential to attain optimum height. “That is because the growth hormone is mainly produced by the pituitary hormone primarily when the child exercises and when it sleeps,” points out Dr. Mahadevan. When it comes to nutrition, in addition to protein, vitamin D and calcium are important too, because ultimately, bones are the basis for height.

“As for physical exercise, in general, any weight-bearing exercise such as running, basketball and football is good for all-round health and vertical growth,” says Dr. Mahadevan.

Reasons for short stature

- Hereditary/genetic

- Inadequate nutrition

- Constitutional delay in growth and puberty

- Systemic diseases (cardiac, kidney, lung and gastro-intestinal).

- Idiopathic short stature

- Hormonal problems (thyroid, pituitary, etc.)

- Psycho-social stress