On 11/21/19, Dr. Dorit Koren MGHfC Pediatric Endocrinologist, met with our clinical staff in our office to discuss normal growth that may be concerning to parents and children as well as abnormal growth patterns.

Phases of Growth
 

There are 4 phases of growth:

1. Fetal growth which is primarily a reflection of maternal health and nutrition
2. Accelerated growth in the 1st 2 years: on average almost 10 inches in 1st year and almost 4 inches in 2ndyear depending on genetics.
3. Steady growth in pre-pubertal years with rate of growth declining gradually before plateauing
4. Acceleration of growth during puberty: Approximately 2-4 inches per year for girls and approximately 3-5 inches per year for boys.

There is no more growth after growth plates close.
 

Measuring Growth
 

We use WHO curves from 0-2 yrs. (length while lying down) and CDC curves from 2-20 yrs. (standing height). On average there is a 0.3inch difference between recumbent height and standing height so growth percentiles may shift slightly during the transition at the 2½-year physical or 3-year physicals.

Growth patterns vary around the world, with Norwegian groups for instance, having higher average growth percentiles than children in the U.S. and Korean children having lower average growth percentiles. Approximately 2% of the US population may have short stature. Short stature may not be abnormal. 

Growth failure is defined as rate of growth below what is expected for age, sex, genetics. and stage of puberty.

• downward crossing of 2 or more major percentiles 
• height dropping below 3rd percentile

Behind the Scenes 
 

Growth hormone is released by the pituitary gland in the brain. Other hormones in our body such as thyroid hormones and the gonadal hormones (estradiol, progesterone and testosterone) stimulate production of growth hormone.

Atypical Growth Patterns

• Benign short stature - NOT abnormal
• Familial short stature: Most, perhaps all, people in family and extended family have short stature
• Constitutional delay of growth and puberty: Puberty is later than average and peak height velocity occurs later.  For example, the boys who are shorter than their peers in middle school and grow in college is totally normal.
• Pathological causes of atypical growth: 
• Under nutrition, malabsorption (celiac disease)
• Neglect
• Hypothyroidism, growth hormone deficiency
• Chronic anemia
• Systemic illnesses such as Crohn’s disease, cancer
• Some chronic medications such as long-term oral steroids

Initial evaluation for abnormal growth pattern will include review of family and pregnancy history, medications. We may do screening blood work and bone age X-rays that typically look at an X-ray of the bones of the hand that stages the radiographic age compared to the actual chronologic age. More studies and imaging may be necessary depending on preliminary tests obtained, if warranted, by a specialist such as Dr. Koren who is a pediatric endocrinologist who sees patients at MGH in Boston and also in Salem and Danvers. 

Your child’s growth charts provides us with a window into typical and atypical growth patterns and can be reassuring although your child may not match his peers in terms of height at a given moment in time. 

We are grateful to Dr. Koren for taking the time to spend with us as we continue with life-long learning in Pediatrics.