My son has always been small. When he was born he was in the 3rd percentile and he has maintained that as he has gotten older. It is not to the point that his size difference to others his age is very noticeable and he is experiencing some discomfort from it. We decided to get him looked at a little closer to see if there was any reason for his small size. After a referral to an Endocrinologist Pediatrician we got a phone assessment after about 4 months. At the assessment it was decided that my son was to get a bone scan of his wrist and some bloodwork. The a follow up appointment about 6 months later. When your son has anxiety, getting bloodwork or any tests is not a simple task. We ended up having to book a special appointment in the pediatric day unit at the hospital where he would not feel rushed and he would get the extra TLC he needed. In the end it still required us to hold him down to get the bloodwork. Days like that remain burned in my memory forever as a parent. After the hospital visit we talked extensively about how it all went and he agreed that it was not that bad. Now my task is to bring it up with him periodically to try to get him to remember how it felt so that he can ease his anxiety about it in the future. Easier said than done.
Well today was the day that we went in for the follow-up appointment and get his test results. Thankfully his blood work came back fine – he is a healthy boy! But his bone scan came back showing that his body thinks it is actually 2 years 7 months younger than it actually is. So my 8 year old actually has a body of a 5 year old. After the Doctor asked if either my husband or I were late bloomers and what our height was, we were told that our son was diagnosed with Constitutional Growth Delay. Of course my heart skipped a beat and I had a million questions starting to form in my mind, but I took a breath and tried to organize my thoughts. Was there something that caused this? Apparently it can be genetics but it also can be for no reason – just happens. Was his brain “immature” too, was his brain not as developed ? No the Dr said, there is no effect on his brain. Was there a correlation between this and his ADHD/Anxiety? No the Dr said there is no connection. Was he going to be small forever? Just until Puberty the Doctor said. He will be a late “bloomer” and if his body does not go into puberty by the time he is 14, we will discuss other options including testosterone injections at that time. Then once he hits puberty he will grow while all the other kids have stopped growing.
What exactly is Constitutional Growth Delay?
Constitutional growth delay is a global delay in development that affects every organ system. Delays in growth and sexual development are quantified by skeletal age, which is determined from bone age radiographic studies of the left hand and wrist. Source: Medscape
Constitutional growth delay is seen in approximately 15% of children and can appear at different stages of their development. It’s important to remember that growth velocity varies accordingly. Between 3 to 6 months to 2 to 3 years of age, the expectation is that some children will cross percentiles in their growth and weight charts without actual concerns for a delay in growth. This tendency will typically resume to a standard rate after this period. After four years of age, there is constant steady growth. It is not until puberty when one will notice that the child starts to divert from the curve, usually because they have late onset of puberty that corresponds to delayed bone age.
Constitutional growth delay and familial short stature are the most common cause of short stature, which means, the child is growing at his/her normal rate and will eventually catch up to the curve if dealing with constitutional delay. In the second disease, familial short stature, the infant has a constant growth rate, but one or both parents are short. This situation typically occurs in parents whom mothers are below 152 cm and fathers 160 cm respectively. Within the differentials of this disease we find, endocrine disorders, that account for GH and IGF-1 disorders, pro-inflammatory cytokines that sometimes have direct affection at the growth plate. Deficiencies in intracellular pathways like SHOX gene affection, problems with cartilage and even paracrine mechanisms are also other causes for stature alteration.
Hussein et al. conducted a prospective study in which they classify the short stature etiology, and found within their population that 26% were the result of endocrine disorders; 11.8% ad GH deficiency, of which 63.6% had normal GH variants, 15.8% had constitutional growth delay, while a combination of both was present in about 5%. Source: NCBI
What causes Constitutional Growth Delay?
Most short children seen by specialists are healthy, and their growth charts usually show that they have been growing close to or slightly below the third or fifth percentile curves but not falling further below over time. In such children, the chances of finding an endocrine problem, such as growth hormone deficiency, or a chronic medical condition serious enough to affect growth that has not already been diagnosed is low. In most cases, the diagnosis will be familial short stature or constitutional growth delay. What are the differences between these 2 diagnoses? Source: PES
What is the Prognosis?
Excellent; children usually catch up, and growth follows the curve that correlates most of the time with their bone age. Source: NCBI
I feel better that we got him looked into and that he will be monitored now for his growth every 6 months. Knowing that he is healthy makes me very happy. He is my little man and he gets to be my little man longer than most kids, so I will consider myself lucky.
Hopefully my story will be helpful to others. If you have any comments I would love to hear them below!
Disclaimer: This has been my experience. I am not a medical Doctor.
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Thanks for sharing Tina. Hugs to you and your son.
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