Around us there are short, up to 150 cm, and tall, up to 2 meters, women and men. These numbers are in no way related to mental abilities; for us these are variants of the norm. They say that a person’s success and self-esteem depend on height. It is believed that tall women are more ambitious than their short friends, and “short” men compensate for the missing centimeters with a successful career and financial situation.
There are those among us who stand out from the crowd. Moreover, short parents may have a son who grows to be two meters tall, while tall parents may have a daughter who will not reach one and a half meters. In adulthood, it is very difficult to influence growth. It is important for parents to regularly measure their child's height. As a rule, dwarfs do not grow more than 130 cm, and giants exceed 2 meters.
Children's growth needs to be closely monitored
Health problems can affect growth: chronic diseases of the respiratory system, heart and blood vessels, gastrointestinal tract, hormonal disorders. Regular use of medications containing hormones, for example to relieve asthma attacks, also slows growth.
It happens that babies who were born with a weight and height below normal grow poorly.
How children grow
1 year of life: + 25 cm.
2nd year of life: + 8-12 cm.
Annual growth: + 4–6 cm.
If during the third year of life the child has grown less than 4 cm, he should be shown to an endocrinologist. Sometimes parents do not pay attention to the fact that their baby is lagging behind his peers in growth, and only realize it in adolescence, when it is already difficult to correct anything. If they had contacted specialists in time, they would have helped the child grow up.
Despite parental care and proper nutrition, 10% of such children, even after 4 years, lag behind their peers. A similar delay can also occur in those children who have one of the parents below 160 cm. But there is no reason to panic - in most children, doctors find only so-called constitutional growth retardation. There is no pathology, but the child remains the smallest in the class for a long time. As a rule, in such children, puberty begins later - at 14–16 years old: thus, nature extends their growth time. Their parents grew up in much the same way: for a long time they were at the bottom of physical education classes, and then suddenly they grew up and found themselves in the top five. These are boys and girls with late puberty. They do not require any treatment; they will catch up, or even surpass their peers by the age of 16–18.
But in some cases, a special examination - carried out only in a hospital - reveals a deficiency of growth hormone (GH) in the body. GH is produced by the pituitary gland under the control of hypothalamic structures. Its deficiency may be genetically determined or associated with disorders in the endocrine system. Previously, the fate of such children was predetermined; they were doomed to dwarf growth: a boy did not grow above 140 cm, and a girl - 130 cm. Today they can be helped.
FOR CALCULATION FANS
There are formulas that allow you to calculate your child's genetically determined height. Their error is quite large: plus or minus 5–10 cm.
Girls = (father’s height in centimeters + mother’s height in centimeters) / 2 – 6.5 cm.
Boys = (father's height in centimeters + mother's height in centimeters) / 2 + 6.5 cm
What is responsible for growth?
Somatotropic hormone (GH), or the so-called “growth hormone,” is responsible for growth in the human body. Sex hormones of the thyroid gland and insulin are also important, but in relation to growth they are active only if there is a normal level of growth hormone. It turns out that a deficiency of one or more of the listed hormones or an excess of adrenal hormones entails growth retardation and without appropriate treatment the matter will not progress.
Fortunately, endocrine growth delays are detected in less than 1% of children. A real lack of growth hormone leads to dwarfism (nanism): then boys grow no more than 140 cm, girls - up to 130 cm. The sooner parents turn to an endocrinologist and receive treatment, the greater the chance that a small patient will grow to average height or even higher. Moreover, if the first child was diagnosed with growth hormone deficiency, and the parents are planning a second one, in most cases the second child does not repeat this hormonal problem.
YOU NEED TO KNOW THIS
Bone (or biological) age shows whether the growth and overall development of bones corresponds to how old and months old the child is. This is a more accurate indicator than height or body weight. In children's bones there are so-called growth zones, due to which the skeleton can increase. These growth plates gradually close towards the end of puberty, the skeleton ossifies and growth stops. Bone age allows doctors to understand how long the child will continue to grow, whether it is necessary to look for hormonal pathology, or whether there is no reason for this. True, even in healthy children, the deviation of bone age from the real one can be up to 3 years.
So that the child grows well
Dairy products, since calcium is a building material for a growing body.
Vegetables and fruits. Carrots containing beta-carotene are especially useful. In order for this microelement to be better absorbed, raw carrots must be grated and seasoned with sour cream or butter.
Protein products - meat, fish, caviar (in the absence of food allergies).
Those children who spend a lot of time outdoors, play outdoor games, and play sports grow better. By the way, if you want your child to be taller, when you choose a sports section, give preference not to strength sports, but to basketball, volleyball, and tennis.
Sleep plays a special role: 70% of growth hormone - somatotropin - is produced at night. If you put your baby to bed late, he sleeps restlessly, often wakes up, and the production of growth hormone is disrupted.
Vegetarianism and observing religious fasts are unacceptable for children, as are fast food and semi-finished products (sausages and sausages - they have almost no complete protein).
Vitamins and minerals. First of all, vitamin D, a deficiency of which develops rickets. Currently, doctors’ recommendations are to give it to all children in a prophylactic dose, approximately 10 mcg per day.
Calcium and iodine. At 6–10 years of age, children should receive 800–1200 mg of calcium and 150 mcg of iodine per day. And teenagers – 1200–1500 mg of calcium and 200 mcg of iodine. The best source of calcium is cottage cheese, but you can’t eat so much of it, so about half of the calcium needs to be taken in tablets. Another option is calcium-fortified foods. As for iodine, only those who live near the sea receive it in abundance: drinking water and seafood there are rich in iodine. Iodized salt is not enough, so iodine supplements are another essential for growth.
________________________________________________________
If the child is a giant
“Growing well, big guy, means good health,” says the proud father, patting his son on the shoulder, who in three months has grown a head taller than him. This is partly true: if the body develops quickly, it means it is healthy. However, it is precisely this very rapid growth rate that makes adolescence a time of increased health risk.
Gigantism (or macrosomia, tall stature) develops in children with incomplete skeletal ossification processes. It is more common in teenage boys, and is detected already at the age of 9-13 years, progressing throughout the entire period of physiological growth. With gigantism, the child's growth rate and indicators by the end of puberty reach more than 1.9 m in women and 2 m in men, while maintaining a relatively proportional physique.
The height of adults from 175 cm to 200 cm is considered sub-giant. People over 200 cm are considered giants.
“Not everything is good, just a lot of it”
The child is growing quickly. Too fast - compared to peers. As a result:
The vessels do not keep pace with the development of tissues, which is why their nutrition deteriorates;
Different parts of the same organs develop unevenly, creating structural defects and interruptions in normal functioning;
Bones that are soft during this period are susceptible to bending due to alternating weakness and tension of different muscle groups pressing on them.
All this leads to the occurrence of adolescent diseases. Their specificity is that a “banal” problem, overlooked during the rapid growth of adulthood, can seriously “undermine” a young organism in just six months.
If the child grows and gets better proportionally, there should be no problems. It’s worse if a child, while rapidly gaining centimeters, also rapidly loses kilograms. These children - thin and tall - are at risk. They most often develop so-called growing pains. In second place at risk are children who are rapidly growing and lead a sedentary lifestyle, who spend a lot of time at the computer or TV: their muscles are very weak, and it is difficult for them to “hold” extra centimeters on themselves.
Cause of tall stature
1. Constitutional-hereditary;
2. Endocrine
3. Chromosomal genetic;
4. Premature sexual development in young children.
What are the dangers of speed?
- Mitral valve prolapse.Occurs in approximately every 10th schoolchild aged 12 to 15 years. Caused by the mitral valve growing faster than the heart tissue (myocardium). The result is a condition similar to a heart defect.
- Curvature of the spine.Growing bones, including the spine, easily take the shape that muscles and loads on the upper shoulder girdle force them to take. If they are significant, then the child has a chance to develop scoliosis - a lateral curvature of the spine. In most cases, six months of physical therapy and massage will be enough to correct your posture. In advanced cases, you will need a special corset.
- Deterioration of vision.The vicious chain of “height – poor posture” has one more link – deterioration of vision. This is a direct consequence of an incorrect position at the table while reading, as well as a lack of lighting in the workplace. The disease can progress until the end of puberty, gaining diopter by diopter. Glasses and vitamins stop the deterioration of vision, but do not return it, because the key point in vision is the weakening of the eye muscles, which they do not affect. The eye muscles are strengthened by hardware vision correction on a video simulator, computer or lens, as well as special massage and treatment.
- Stretch marks.Many children whose growth is accompanied by weight gain develop large red and then whitish stretch marks on their bodies. This happens due to the fact that the skin of adolescents is thinner, easily stretched and injured, and the subcutaneous fat layer grows faster than the skin. As a result, the skin stretches and is replaced in areas of growth with connective tissue. However, sometimes the cause of stretch marks is hormonal imbalances, which may or may not have anything to do with growth.
REFERENCE
“Giant” children complain of fatigue and weakness, dizziness, headaches, blurred vision, pain in joints and bones. Decreased memory and performance capacity lead to deterioration in school performance. Gigantism is characterized by hormonal disorders, mental and sexual function disorders.
Is it possible to identify and treat growth disorders?
It is good when signs of dwarfism or gigantism are noticed in childhood. If a child is 2 years behind or ahead of his peers in growth, you need to consult a doctor.
Of course, the constitution and height of the parents are taken into account here. Doctors must conduct a comprehensive examination of the child. The level of somatotropic hormone in the blood is determined, and an X-ray examination of the skull is performed. Treatment is carried out by an endocrinologist. In case of growth hormone deficiency, replacement therapy is prescribed. This means that until a certain age the child will take pills that contain growth hormone. Often with dwarfism, there is a lack of thyroid hormones and sex hormones. They can also be replaced with drugs. This treatment has a good effect if started before 5–7 years of age. In parallel with hormones, medications are prescribed that improve metabolism and promote muscle growth. Parents should also take care of good nutrition for their child, since bone growth requires a lot of “building material.”
Treatment of gigantism depends on the cause of its occurrence. Therapy should begin in childhood - only then will children with short stature “catch up” with their peers, and very tall children will stop growing at an “accelerated” pace.
We thank the endocrinologist of the YMC for his help in preparing the material Anna Petrova and pediatrician Svetlana Sofronova.
Being ahead of a child in growth can be called a condition when the child’s growth rate is significantly ahead of the average, i.e. is outside the 95th centile in the growth chart for children of this age (outside the norm).
If the child is significantly ahead in growth, first of all, it is necessary to draw the attention of the pediatrician observing the child to this condition and examine the child with specialists (endocrinologist, cardiologist, geneticist, etc.).
Tall stature in healthy children.
The increasing incidence of so-called constitutional tall stature, which has no pathological basis and is characteristic of completely healthy children, has become a relatively new pediatric problem. The excessively tall height of girls often forces parents to seek medical help. For certain indications, such children may be treated with hormonal drugs that inhibit growth and enhance skeletal maturation. Most often, diethylstilbestrol, estrogen conjugates, and estradiol are used for these purposes. In relation to the predicted final height, such “treatment” for 1.5–2 years can result in a growth delay of 4–8 cm.
Tall healthy boys very rarely cause concern for parents and children themselves. Only in cases of Marfan disease, where aortic aneurysmization increases in parallel with intensive skeletal growth and in proportion to it, can there be indications for growth inhibition with adrenal androgens or testosterone.
However, regardless of the reasons for tall stature, it is necessary to monitor the child’s health, since active skeletal growth entails active growth of internal tissues and organs, which can negatively affect their functioning. This is especially true of the heart. Parents need to be especially careful during periods of active skeletal growth (5-7 years and 12-16 years). If active growth is accompanied by internal pain or disturbances in the functioning of internal organs, you should consult a doctor.
Possible reasons for a child being ahead in growth are tall stature.
Pathological tall stature is much less common than short stature. It is necessary to distinguish between transient forms of tallness and tallness that persists until the end of the extension period.
Transient forms include greater length and body weight in the intrauterine fetus of a woman suffering from diabetes. Sometimes, already in postnatal development, accelerated growth of children with hyperfunction of the thyroid gland or increased production of adrenal androgens is temporarily observed.
Persistent forms of tall stature can be of a chromosomal nature, in particular, they are characteristic of carriers of an additional Y chromosome - sets 47 XYY or 48 XXYY. Congenital syndromes, the component of which is tallness, or gigantism, are extremely rare. These include Wiedemann-Beckwitt syndrome, Berardinelli lipodystrophy, Marfan disease and one form of amino acid metabolism disorder - homocystinuria.
The congenital form of cerebral gigantism is characterized not only by tall stature, but also by its combination with profound mental retardation and anomalies of the craniofacial region.
Gigantism in children that occurs during postnatal development may also be of a pituitary nature, i.e. determined by hyperproduction of somatotropic hormone of the pituitary gland. In the vast majority of cases, the cause of such hyperproduction is a tumor of the adenohypophysis.
Diagnosis of the causes of tall stature
To clarify the diagnosis, parents should be interviewed and determine whether there is a hereditary-constitutional form that does not require any treatment. In some cases, if a genetic chromosomal pathology is suspected, consultation with a geneticist and genetic analysis may be required. In addition, an analysis should be carried out to determine the level of growth hormones - growth hormone and IGF-1, amino acids, glucose in the blood, as well as examinations for the content of thyroid hormones. In some cases, an MRI, tissue biopsy (if the adrenal glands are affected), radiography, ultrasound, and so on may be required.
When collecting anamnesis, attention should be paid to height and birth weight. Thus, with Marfan, Beckwith-Wiedemann, Simpson-Golabi-Bemel, Banayan-Riley-Ruvalcaba syndromes and constitutional tallness, high values of body length at birth are noted.
Treatment of tall stature
If the cause of tall stature is concomitant diseases, they should be treated. For example, in case of adrenal tumors, they are removed followed by replacement therapy. Otherwise, according to indications, hormonal therapy can be carried out to slow growth to a socially acceptable level.
Tallnessimplies high rates of linear growth of the child, exceeding the average rates for a given chronological age and gender. Tallness- not a disease, but more often a sign of excessive physical development, however, it is one of the leading symptoms of endocrine pathology such as gigantism and acromegaly. Gigantism- a disease associated with excessive production of growth hormone by the adenohypophysis. The cause of the development of gigantism is a pathology of the hypothalamic-pituitary region, which develops as a result of tumors, neuroinfection, intoxication, and traumatic brain injury. GigantismIt is more often observed in boys of pre- and pubertal age. Characterized by high rates of dew, fatigue, weakness, decreased performance and performance at school, headaches, dizziness, and possible visual impairment. Body proportions are preserved. Rapid development of the hands and feet and delayed sexual development are noted. In the presence of a growing pituitary adenoma, along with general cerebral symptoms, visual acuity and visual field narrowing gradually decrease. AcromegalyIt is extremely rare in children. With acromegaly, there is varying sensitivity of peripheral tissues to growth hormone. All cerebral symptoms are more pronounced than with gigantism. Children often complain of bone pain, muscle weakness, and loss of smell. Characterized by disproportionate growth of the skeleton and soft tissues: an increase in the superciliary and zygomatic arches, the lower jaw and the spaces between the teeth, a significant thickening of all bones, an increase in the phalanges of the fingers and heel bone, the appearance of bone outgrowths - spines. The growth of soft tissues leads to characteristic disfigurement of the face due to thickening of the nose and loss of the ears. An increase in the size of the tongue causes dysarthria, thickening of the vocal cords causes a deepening of the voice. There are symptoms of hypogonadism. TO rare genetic forms of tall stature include: Marfan syndrome is characterized by: tall stature, “spider” fingers, dolichocephaly, chest deformation, scoliosis, underweight, heart defects, ophthalmological disorders; Sotos symptoms are characterized by: acromegaly, lack of coordination, mental retardation; Pyle's symptoms are characterized by: disproportionate long lower limbs, valgus deviation of the knee joints, limited extension of the elbow joints; Homocystinuria is characterized by: osteoporosis, a tendency to fractures, optic nerve atrophy, arterial thrombosis, mental retardation, a phenotype similar to Marfan syndrome. Hermaphroditismaccompanied by an abnormal (bisexual) structure of the external genitalia. Anomalies in the structure of the external genitalia in persons with a female genetic sex (karyotype 46 XX) are usually designated by the term “false female hermaphroditism”, anomalies in persons with a male genetic sex (karyotype 46 XY) are called “false male hermaphroditism”, with the exception of a rare form - true hermaphroditism , in which the presence of a karyotype 46 XY, 46 XX or 46 XY\46 XX is possible. The external genitalia have a bisexual structure with varying degrees of virilization. Internal genitalia, as a rule, have female features: there is a uterus (often one-horned), a vagina, and tubes. At puberty, patients tend to have predominantly female characteristics. Diagnosis of hermaphrodism
It is necessary to begin examining children, first of all, by determining sex chromatin and karyotype. Detection of positive sex chromatin and karyotype 46 XX most likely indicate false female hermaphroditism. An accurate diagnosis can be made only by laparotomy, macroscopic and histological examination of the gonads. In the case of negative sex chromatin, a differential diagnosis should be made between various forms of false male hermaphroditism. The presence of the uterus, tubes and vagina with karyotype 46 XY and mosaic 46 XY\45 X0 suggests the presence of testicular dysgenesis syndrome. Much less often, gonadal bisexuality (true hermaphroditism) can be detected. With a karyotype of 46 XY and the absence of the uterus and upper third of the vagina, one should think about the syndrome of incomplete masculinization. A significant difficulty is the differential diagnosis between the incomplete form of masculinization and the incomplete form of testicular feminization. The difference is revealed only during the puberty period, when in children with an incomplete form of testicular feminization, the mammary glands spontaneously begin to develop, the figure develops according to the female type, and with the syndrome of incomplete masculinization, all the signs of the male puberty are noted. Treatment of hermaphrodism
In front of everyone forms of false female hermaphroditism the choice of the female gender is beyond doubt. In case of congenital dysfunction of the adrenal cortex, adequate and timely therapy with cortisol drugs avoids further villization and creates the preconditions for further physiological formation of the ovaries. With false male hermaphroditism with satisfactory development of the corpora cavernosa of the penis, the male gender is selected and masculinizing genital plastic surgery is performed. With true hermaphroditism The choice of female gender is desirable. Feminizing genital plastic surgery is performed.
Changes in the production of hormones by the adrenal glands result in a variety of health effects. With their excessive activity, puberty occurs faster. If disturbances affect the medulla of the glands, the person develops arterial hypertension. Decreased adrenal function can lead to the development of Addison's disease, or, as it is also called, bronze disease. It is characterized by: skin pigmentation, exhaustion, decreased blood pressure, low sugar levels. With bronze disease, the body's resistance decreases. Dysfunction of the endocrine system can also manifest itself in changes in the activity of the gonads. Hormone production increases, mainly due to the development of malignant tumors. When the functions of the gonads decrease, a disease such as eunuchoidism is diagnosed. This disease manifests itself in excessive growth of the limbs with their abnormal lengthening, the appearance of a tendency towards obesity, underdevelopment of the genital organs and the absence of some secondary sexual characteristics.
Recurrence of a brain tumor (there is no supporting data, and currently this is not given much importance).
Leukemia (seen in children undergoing chemotherapy or radiation therapy; it is unclear whether it increases Therapy, -i; and. 1. A branch of clinical medicine that studies the causes and mechanisms of development of internal diseases, their diagnosis, treatment and prevention. From Greek therapeia - treatment. 2. The totality of diff. conservative methods of treating diseases without surgery. Treatment methods: medications (pharmacotherapy), including antibacterial (chemotherapy, antibiotic therapy) and hormonal (hormone therapy); serums and vaccines (vaccine and serotherapy)
" data-tipmaxwidth="500" data-tiptheme="tipthemeflatdarklight" data-tipdelayclose="1000" data-tipeventout="mouseout" data-tipmouseleave="false" class="jqeasytooltip jqeasytooltip20" id="jqeasytooltip20" title=" Therapy">терапия!} GR already increases the risk of developing leukemia in such cases).Metastasis and tumor development (a slight increase in long-term risk of metastasis and cancer has recently been described in surviving children receiving GH; these data require confirmation and their clinical significance remains unclear).
47. Should children with idiopathic hyperplasia (i.e., in the absence of GH deficiency) be treated with growth hormone?
The FDA recently approved the use of srota hormone in children with idiopathic short stature and expected final height.< 160 см у мальчиков и < 150 см у девочек. Однако целесообразность такого лечения в отсутствие нарушений секреции ГР оспаривается многими детскими эндокринологами. Результаты кратковременных исследований, включавших небольшие группы детей, свидетельствуют об увеличении скорости роста при лечении ГР в таких случаях. Там же, где детей наблюдали до достижения окончательного роста, были получены противоречивые результаты. Однако большинство исследователей подчеркивают незначительное увеличение окончательного роста, которого можно добиться, к тому же, ценой значительных финансовых затрат. Таким образом, применять ГР у таких детей можно лишь после детального обсуждения с ребенком, членами его семьи я опытным детским эндокринологом, хорошо знающим больного.
48. How do growth dynamics differ in children with an excess of glucocorticoids and with exogenous obesity?
With an excess of glucocorticoids, both iatrogenic (often) and endogenous (rarely), the growth of children slows down. This is due to the direct effect of glucocorticoids on metabolism - stimulation of breakdown and lipolysis and inhibition of collagen synthesis. They also suppress the pulsed secretion of GH by the pituitary gland and the production of IGF-1 by target tissues. All this often leads to short stature in children. In addition, in such children the weight-to-height ratio increases and develops ожирение!}. On the other hand, with exogenous obesity, growth is usually accelerated, and such children are usually taller than their peers.
49. What conditions are characterized by accelerated growth in childhood?
Excessive growth in childhood occurs in a relatively small number of conditions. These include familial tall stature (where the child's final height roughly matches that of the parents), constitutional tall stature, hormonal disorders and genetic syndromes.
50. What is constitutional tallness?
With constitutional tallness, the bone height is ahead of the chronological height, the growth rate is increased, and sexual development begins earlier than usual; the expected final height in such cases corresponds to the height of the parents. Obesity and heredity may play a role in the pathogenesis of this condition.
