Growth in Children

The most important difference between a child and an adult is growth. The term growth refers to the increase of the body's dimensions such as length and weight while the term development means the progression of functions such as start walking and talking. The child's body grows and mind develops. Growth and developmental retardation can sometimes be seen together. However, these two situations should be kept apart. In Live Hospital, pediatricians and especially pediatric endocrine specialists deal with growth retardation, while pediatric development and neurology specialists deal with children with developmental retardation.


Is there growth retardation?

A child's growth in the height over a period of time, for example within 6 months or 1 year, is called the growth rate. While the average growth rate in the height in the first year of life is 25 cm; it is 12 cm in the second year, 8 cm in the third year and around 5-6 cm in a year within the period from the age of six to adolescence. Growth retardation is that the growth rate in a time period is lower than the peers. For example, if a child between the age of six and adolescence has an annual growth less than 4.5 cm, growth retardation can be mentioned. Growth curves are used to evaluate the growth rate. During the first two years of life, up or down physiological deviations may be observed in the growth curve. If a down deviation is observed in the growth curve of a child older than two years, there is growth retardation. Even if the child's height is normal, a disease should be investigated if there is growth retardation.


What is the average height in Turkey according to current data?

Average height at birth is 50 cm. A baby grows 25 cm in the first year and reaches 1.5 times the length of birth. Then the growth rate slows down gradually; the average of the second year is 12 cm, 8 cm in the third year and 7 cm in the fourth year. Therefore, children reach an average height of 102 cm at the age of four, i.e. 2 times the birth height. Growth rate per year continues average 5-6 cm in subsequent years until adolescence. Thus, at the age of 12, boys reach an average of 150 cm while girls reach an average of 153 cm, i.e. 3 times the birth height. According to the study conducted by Olcay Neyzi et al in 2008, the final adult height in our country is average 163 cm in girls and 176 cm in boys.


How do we know the growth of children is complete?

If the growth rate falls below 1 cm per year, the growth is almost complete. At the end of adolescence, 99 percent of the adult height is completed. After the growth plates of the long bones are closed, the final height is reached with the increase of vertebral lengths and a further elongation of the body. Girls reach the adult height at about 16 years old and boys at 18 years old. In fact, these ages are bone ages, and mostly the calendar and bone ages of individuals are compatible with each other. However, early or late onset of adolescence affects bone age and may change the calendar age at which growth is complete. In early adolescents, growth plates close earlier and growth is completed sooner. To determine the bone age of children, radiological evaluation of wrist bones is required. The child has completed the growth if all the growth plates are closed.


How long does the height grow during adolescence?

The growth of boys and girls differs during adolescence. This difference ensures that adult height averages are different. Girls’ growth in puberty starts and ends 2 years ago compared to boys. Less growth in the height in girls for two years makes a difference of 8-10 cm. In adolescence, boys grow by 25-30 cm in total while girls grow by 20-25 cm. This causes a difference of about 3-5 cm. Thus, the average adult height of boys (176 cm) is approximately 13 cm taller than girls (163 cm).


How does early adolescence affect growth?

The child grows 5-6 cm in the height before adolescence and the growth of the child continues again after adolescence. Increased sex hormones in adolescence, especially the hormone estrogen, accelerate the maturation of bones and thus the closure of growth plates. Adolescence is a period in which growth accelerates on the one hand and completes on the other. As early adolescence causes the child to grow faster than their peers, it leads to longer height in the beginning. However, because the growth plates are closed earlier and growth ends early, the final height remains short. This is especially true for early adolescence that begins at a young age and demonstrates a rapid course. Early adolescence does not always adversely affect growth. Every child with suspected early adolescence needs to be specifically evaluated by endocrinologists.


Does delayed puberty also cause problems?

Since growth attack dose not start in children with delayed puberty, height difference may occur. In addition, chronic diseases that may cause delayed puberty may adversely affect growth in children. Delayed puberty in children is most commonly seen as part of the structural growth delay. Such children are usually brought due to the complaint of short stature around the age of 10-14. Bone age in children with structural delay is 2-3 years behind. Thus, they reach puberty late, grow later than their peers, and the growth may take 20-21 years to complete. This is the opposite of early puberty. The height is shorter than its peers at the beginning, but reaches normal limits with late closure of growth plates.

There may be disproportionate body proportions.

Some children with delayed puberty has persistent problems; puberty does not start at all or is not complete even if it starts. Since the sex hormones are missing in these children, the closure of growth plates is delayed and therefore the growth of the height continues. The proportion of the body deteriorates because the arms and legs are mostly lengthened during this period. The leg length becomes disproportionately long compared to the body; likewise, the arm span becomes longer than the height. A disproportionate body structure with the longer arms and legs may form in children with delayed puberty.


Is the height normal?

The height of the child is assessed based on the growth tables and curves developed for the society. If the height is below 3 percent according to the age group, the child has a short stature. The height is within normal ranges if it is between 3-97 percent.

If the child does not grow long?

A child who does not grow long enough can have many problems. Growth hormone deficiency can be investigated after excluding other causes. Malnutrition is the most common cause of growth retardation. Malnutrition develops due to inadequate food intake in the backward countries, whereas it occurs due to chronic diseases in developed countries. Growth retardation may be the first and only sign of chronic diseases. Bone diseases and genetic diseases can also cause short stature. Therefore, investigations should be made primarily to reveal any malnutrition, chronic diseases and skeletal and genetic diseases. If there is no reason to explain paused growth, tests are conducted to reveal any growth hormone deficiency. To do this, warning tests are conducted after administering drug.

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