Child Height and Puberty Assessment

Short answer: It is worth getting a child's growth checked if they are much shorter than other children of the same age, are clearly shorter than expected for the parents' heights, or are growing more slowly than before. Puberty that starts very early or has not started by the expected age also needs an assessment. The first visit usually involves accurate measurement, plotting on Indian growth charts, an examination, and often a bone age X-ray and blood tests.

Height and puberty are among the most common worries parents bring to a hormone specialist. Many children who seem short are healthy and simply follow their family pattern or are "late bloomers". A careful assessment separates those children from the smaller group who have a treatable cause. For background, read is my child too short? and early or late puberty.

When should I worry about my child's height or puberty timing?

A single height measurement says less than a pattern over time. It is worth seeing a doctor if:

your child is much shorter than most children of the same age and sex;
your child is clearly shorter than expected from both parents' heights;
your child has been growing slowly, for example needing new clothes and shoes much less often than before, or falling behind classmates year after year;
short height comes with other symptoms, such as poor appetite, tummy problems, tiredness, headaches or unusual body proportions.

For puberty, doctors usually look closer when:

a girl shows breast development before about 8 years, or a boy shows genital or testicular enlargement before about 9 years;
a girl has no breast development by about 13 years, or a boy has no testicular enlargement by about 14 years;
puberty starts but then stops, or progresses unusually fast.

What should I bring to the appointment?

Good records make the assessment much more accurate. Please bring:

Past height and weight records, for example from school health cards, the paediatrician's notes or the vaccination card.
Both parents' heights, measured if possible, not guessed. If a parent cannot attend, please measure them at home.
Old photographs, such as school or family photos from different years, if past measurements are not available. They can show when a child started to fall behind.
Birth details, such as birth weight and whether the baby was born early.
Any previous blood tests or X-rays.
A list of any medicines, including inhalers, steroid creams or supplements.

What happens at the visit?

The first assessment usually includes:

Accurate measurement of height (standing, without shoes) and weight, and sometimes sitting height and arm span.
Plotting on growth charts. In India, doctors commonly use the Indian Academy of Pediatrics (IAP) growth charts, made from measurements of Indian children. The chart shows where your child stands compared with other children of the same age, and whether they are tracking along their expected line.
A target height calculated from the parents' heights, so the doctor can see whether your child's growth matches the family pattern.
A physical examination, including the stage of puberty, assessed sensitively and with a parent present.
A bone age X-ray, usually of the left hand and wrist. It shows how mature the bones are, which helps judge how much growth is left.
Blood tests when needed, such as a blood count, thyroid function, tests for coeliac disease, kidney and liver tests, and sometimes growth or puberty hormones.

What happens next?

After the first assessment, most families fall into one of three groups:

Reassurance and monitoring. Many children have a family pattern of short stature or a constitutional delay in growth and puberty. They need repeat measurements, usually after several months, to confirm normal growth speed.
Further tests. If a cause is suspected, more specific tests may be needed. Some hormone tests, such as growth hormone stimulation tests, are done under supervision.
Treatment. When a treatable cause is found, such as an underactive thyroid, growth hormone deficiency or early puberty, your doctor will explain the options, the benefits and the risks. Treatment decisions are made together with the family.

Growth assessment is done over time, so follow-up visits are an important part of the process.

When to see a doctor urgently

Seek urgent care if your child has: a severe or worsening headache with vomiting, especially in the morning, sudden changes in vision, fits (seizures), extreme thirst and passing large amounts of urine with weight loss, or becomes very drowsy or confused. Go to the nearest emergency department immediately, or call 108 or 112.

Book a consultation with Dr. Om J Lakhani at AB Plus Hospital, Ahmedabad, or online → consult.dromlakhani.com. Call +91 73738 48848 for appointments.

References

Khadilkar V, et al. Revised IAP growth charts for height, weight and body mass index for 5- to 18-year-old Indian children. Indian Pediatr. 2015. PubMed
Grimberg A, et al. Guidelines for Growth Hormone and Insulin-Like Growth Factor-I Treatment in Children and Adolescents: Growth Hormone Deficiency, Idiopathic Short Stature, and Primary Insulin-Like Growth Factor-I Deficiency. Horm Res Paediatr. 2016. PubMed
Carel JC, et al. Consensus statement on the use of gonadotropin-releasing hormone analogs in children. Pediatrics. 2009. PubMed
Palmert MR, et al. Clinical practice. Delayed puberty. N Engl J Med. 2012. PubMed

Child's height or puberty worries? What a paediatric endocrinology assessment involves in Gujarat