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Suggest Treatment For Low Growth Velocity In A 15 Year Old
Question: My 15 year old son only grew a 1/2 inch over the past year (confirmed at annual checkup last week). I've been concerned about his growth as I watch all the other boys jump up in growth this past year. He went from 5'5.5" to 5'6" inches from 14 1/2 to 15 1/2 years old. He had been tracking at 50% on growth chart his entire life with estimated height between 5.9-5.10 inches. He had dropped to below 20% on growth chart at this last visit. Based on this, the doctor ordered a hand xray. They just called and said it showed a bone age of 17 years. Please tell me what I can do now to help him grow. Will he just stop now at only being 5 ft 6 in? I sure hope not. It there is only a short time left for him to grow - please tell me what I should do. Obviously something is wrong if he has fallen to below 20% on growth chart at a time he should be growing. Can he get put on GH to help him with what little time he has left. Huge thank you!
Brief Answer:
Very little we can do
Detailed Answer:
Hi
Here are my opinion based on the details you have provided :
1. His age is 15.5 and height is 167 cm , based on this his Height SDS score is -0.7 and he should be around the 25th percentile on the growth chart. Based on this he does not fall into the definition of short stature. Also, assessment for growth hormone deficiency or treatment with GH (growth hormone) is not indicated for this level of treatment.
2. His growth velocity is around 1.2 cm which is low. This does need assessment.
3. He has fallen off 20% of the growth chart which is important.
4. His bone age is advanced by around 1.5 to 2 years which again is significant.
Now, we will need some more information from you:
1. Do you have reports of any recent blood tests done for him ?
2. What was the age of his pubertal onset (if you are aware) ?
3. What are the height of the father and mother of the child (we need to calculated the Midparental height based on this) ?
4. Can you share the picture of the Hand Xray (in our opinion radiologist often make an error in interpretation of the bone age Xray)
5. What is his exact birth date ?
It seems in his case based on the advanced bone age that he was probably an 'early bloomer' . Because of his advanced bone age , the growth velocity is slow at present. If his growth plate has not fused he may still gain one inch or two at the most. If the growth plate is fused or close to fusion there is very little we can do to help his height at this point. Some people may GnRH agonist injections, but in our opinion it would help little at this age and may cause long term harm to the bones. Growth hormone is not indicated at present.
The growth depends on the bone age and not the chronological age and hence for all practical purposes his age as far as the growth is concerned is 17. At this age, the height gain expected is not much, but an inch or two on the optimistic side.
I would advice you to get done free T4 and TSH for the advanced bone age. I would also advise a celiac disease screen (Serum IgA and IgA anti-tTg) consider that fact that he has fallen off the growth curve.
Hope this was helpful
Regards
Dr. Om J Lakhani, MD
Department of Endocrinology
Sir XXXXXXX XXXXXXX Hospital,
New XXXXXXX
Very little we can do
Detailed Answer:
Hi
Here are my opinion based on the details you have provided :
1. His age is 15.5 and height is 167 cm , based on this his Height SDS score is -0.7 and he should be around the 25th percentile on the growth chart. Based on this he does not fall into the definition of short stature. Also, assessment for growth hormone deficiency or treatment with GH (growth hormone) is not indicated for this level of treatment.
2. His growth velocity is around 1.2 cm which is low. This does need assessment.
3. He has fallen off 20% of the growth chart which is important.
4. His bone age is advanced by around 1.5 to 2 years which again is significant.
Now, we will need some more information from you:
1. Do you have reports of any recent blood tests done for him ?
2. What was the age of his pubertal onset (if you are aware) ?
3. What are the height of the father and mother of the child (we need to calculated the Midparental height based on this) ?
4. Can you share the picture of the Hand Xray (in our opinion radiologist often make an error in interpretation of the bone age Xray)
5. What is his exact birth date ?
It seems in his case based on the advanced bone age that he was probably an 'early bloomer' . Because of his advanced bone age , the growth velocity is slow at present. If his growth plate has not fused he may still gain one inch or two at the most. If the growth plate is fused or close to fusion there is very little we can do to help his height at this point. Some people may GnRH agonist injections, but in our opinion it would help little at this age and may cause long term harm to the bones. Growth hormone is not indicated at present.
The growth depends on the bone age and not the chronological age and hence for all practical purposes his age as far as the growth is concerned is 17. At this age, the height gain expected is not much, but an inch or two on the optimistic side.
I would advice you to get done free T4 and TSH for the advanced bone age. I would also advise a celiac disease screen (Serum IgA and IgA anti-tTg) consider that fact that he has fallen off the growth curve.
Hope this was helpful
Regards
Dr. Om J Lakhani, MD
Department of Endocrinology
Sir XXXXXXX XXXXXXX Hospital,
New XXXXXXX
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Above answer was peer-reviewed by :
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