|
|
|
: A small child does not necessarily become
a small adult
DEAR DR.PAUL: My 11-year-old son, is the smallest in the
class and the shortest on his baseball team. He is teased by his
classmates all the time. What can I tell him? Will he always be
small or will his growth catch up to his peers?
PEDIATRICIAN DR.PAUL Answers: As you know, no two children
are alike. Each child grows and develops at his or her own pace.
Your son is a pre-teen, and I would imagine that in his class
the other children are all starting to grow and experience pubertal
changes. Girls are a bit ahead in this category because they
tend to go into puberty earlier than boys.
When I evaluate a boy such as yours, the first thing I want
to see is the growth curve. If the curve shows that the child
is following a steady growth rate - albeit lower than average
- this is reassuring.
Looking at pubertal changes is also important, and in cases
such as your son's puberty has not begun yet. Finally, given
that there are no other medical problems (and there usually
are none), we have to look at the family history. How tall are
the parents? On average, the height a child will reach is somewhere
between the mother's and the father's.
Is there a history of small-sized people in the family? And
importantly, what pattern did the father show during his pre-teen
and teen years? It's important to make a distinction as to the
cause of the small size: is it a family trait or a constitutional
growth delay? I would like to spend some time on this latter
condition, as we see it quite frequently in boys in situations
similar to your son's.
Boys with constitutional growth delay typically lag behind their
classmates and friends in growth rate, size and onset of sexual
characteristic (pubertal) development. However, at one point,
usually in the mid-teen years, puberty begins, and they grow
and catch up to become as tall, or taller, than their peers.
In most cases the father will have had experienced the same
pattern during his adolescence.
How does one confirm or identify constitutional growth delay?
The family history and pattern of growth of both the father
and child are important clues. In general, this is enough to
convince us. However a simple X-ray of the wrist can help. It
is interesting to know that there is such a thing as "bone age",
which reflects the state of growth of a person's body. The X-ray
is compared to standard reference X-rays and a bone age is assigned.
For example, a normal 20-year old person will have a bone age
of a 20-year-old. In constitutional growth delay, a 12-year-old
boy might have a bone age of a 10-year old boy. This delay in
bone age tells us that the child is behind in growth and that
there will be a catch up.
Knowing this will, of course, reassure the parents, but most
importantly this information is reassuring to the child and
will likely be a boost to his self-esteem.
|
|
The information provided in this site is
designed to be an educational aid only. It is not intended to
replace the advice and care of your child's physician, nor is
it intended to be used for medical diagnosis or treatment. If
you suspect that your child has a medical condition, always
consult a physician.
© Autograph Communications Inc.,
All rights reserved
|
|
|
|
