On the 20th September 2020, organisations united globally to promote the educational initiative of International Children’s Growth Awareness. The goal is to share and support the key message of the campaign in order to inform parents about the importance of annual and regular growth checks for their children1.Children’s Growth Awareness Week was also commemorated in September between 13 – 19 September, 2020
Growth hormone deficiency
The growth of a child is a significant indication of the child’s health and irregular growth can be an early warning sign of medical problems.1 These kinds of medical problems first show themselves in a child’s irregular growth pattern.1 Growth hormone deficiency has been identified in about 1 in every 3,800 children.2
Therefore, it is important for parents to understand the significance of regularly checking their child’s growth development. This can be done during visits to your healthcare practitioner. For additional support and tracking, an easy to download growth app was launched this September 2020, in order to help parents to easily track their child’s growth.
“Growth is one of the fundamental differences between child and adult health care. Physical growth is an indicator and predictor of both present and future health. Among the numerous measures of growth, height and weight are perhaps the most important measures in childhood. While weight may change in adult life, height changes from conception to shortly after the end of puberty.” Says Dr Kuben Pillay, a Paediatric Endocrinologist from Durban.
Human growth hormone is a chemical messenger that is vital for normal growth and development.3 Growth hormone is responsible for making us grow and in our bodies, growth hormone is produced naturally.
When a child is diagnosed as growth hormone deficient, it means his or her pituitary gland is not producing enough growth hormone.4 This could be due to hereditary or genetic conditions. Without enough growth hormone, a child does not grow the way he or she should, to reach his genetic potential or height and to attain well-being.
According to Dr Pillay “Changes in patterns of growth may occur during any of 3 different growth phases through childhood and may be due to numerous different causes. These phases are the period between conception and the end of the first year of life (the infant phase), from approximately 1 year of age until the start of puberty (child phase) and between the start and end of puberty. There are different causes that may change growth in these phases and thus, the timing of the change in growth may offer important clues to the underlying cause. For example, nutrition both in the womb and after delivery may result in changes in patterns of growth during the infant phase. Congenital abnormalities (particularly bone abnormalities) and genetic disorders may also be causes. During the child phase many more possibilities may influence growth including genetic disorders (e.g. Turner syndrome), severe chronic disease (heart disease, severe asthma, kidney, etc.), severe malnutrition and hormonal disorders. Growth in puberty is due to effects of the hormones of puberty viz. testosterone in boys and oestrogen in girls.”
How to measure growth and treat a possible growth hormone deficiency
- The typical growth of a child, which would be considered normal, is as follows:4
- From birth, infants grow about 20 cm in the first year of life
- From 1 to 2 years of age, babies and toddlers grow about 10 to 13 cm
- From 2 to 3 years of age, toddlers grow at a rate of about 7.5 to 10 cm
- From age 3 years to puberty, growth is stable at around 5 to 6 cm per year until puberty
Most of a child’s growth occurs before puberty, but the pubertal growth spurt accounts for more than 20% of adult height.4
When puberty occurs, there is a fast phase of growth. With this guide, parents can easily notice whether their child reaches the growth requirements.
If, however, your child does not meet the growth requirements, he or she might need to consult with a healthcare professional, undergo tests and possibly undergo growth hormone therapy.
Growth hormones are also vital for the healthy development of essentially all tissues in the body, including muscle and bone.3 It is important that children who are growth hormone deficient are diagnosed and treated as early as possible in order to aid their bones in growing and developing at a normal pace. Children with severe growth hormone deficiency show increased body fat, subnormal bone mineral density, and reduced lean body mass and could potentially develop lipid abnormalities.5 Once a child is tested for growth hormone deficiency related disorders such as short stature, a methodical approach is necessary.6 An evaluation of growth failure is needed and if there is no evidence suggesting growth hormone deficiency, then other tests are done. If there are abnormalities suggesting growth hormone deficiency, then growth hormone stimulation tests and an MRI of the brain could be suggested.6
If a child does not undergo treatment once diagnosed with growth deficiency, he or she might not attain a normal height etc., when becoming an adult.7 Once a child is on a treatment plan, strict adherence is important to achieve the maximal benefits of growth hormone therapy. Early initiation of growth hormone treatment in children with isolated growth hormone deficiency improves their chance of achieving their genetic height potential.8 Once a diagnosis of growth hormone deficiency has been made, it is recommended that treatment with GH is initiated as soon as possible.8 The first year is a crucial indicator.8 Children who are on hormone treatment typically grow more over the first year of treatment, and further over the next 2 years.9
“Growth hormone continues to play an important metabolic role in adulthood long after the completion of linear growth, so growth hormone may become a lifelong therapy for children with childhood growth hormone deficiency whose condition persists into adulthood,” says Professor Thandrayen, Paediatric Endocrinologist at Chris Hani Baragwanath Academic Hospital.
If effective, therapy should be continued for as long as there is a clinical benefit (defined as ongoing catch-up growth or maintenance of a normal growth velocity).5
The Growth Journey App
To aid parents in checking their children’s growth, Novo Nordisk has launched an app for growth monitoring in September 2020 called the Growth Journey App.
The Growth Journey App is a free growth tracking app that uses a phone’s camera to help you track a child’s growth regularly.10 Parents can easily track their child’s growth as the app automatically measures a child’s height and records it in the growth book with a visual record of all the measurements. It also shows the child’s growth over time and compares it to those of other children in his or her age group.
The aim for the launch of this app is to enhance awareness regarding growth and short stature, remove obstacles for diagnosis and support early referral to specialists, enhance compliance on treatment and loyalty for existing patients and to establish initial screening of patients. This innovative digital solution is intended to provide simplicity and empower parents to take their children’s growth journey in their hands. The app is available on Play Store on Android and iPhone at no cost to download.
It is important for parents to know what their child’s growth rate is and what it should be at any age. If a child is not growing as he or she should, it could be the first sign of a possible medical condition.1 Parents should consult with their doctor for more details. It is impossible to manage what cannot be measured; therefore, it is crucial that children are measured frequently.7 This is especially important when children visit their health care providers and parents can now also monitor their child’s growth through the Growth Journey App.
About Novo Nordisk
Novo Nordisk is a global healthcare company that helps people with diabetes, obesity, haemophilia, growth disorders and other serious chronic disorders. Novo Nordisk is headquartered in Denmark, and the South African affiliate was established in 1959 and currently employs 135 people who work within the South African borders only.
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- NCBI. Early growth hormone treatment start in childhood growth hormone deficiency improves near adult height: analysis from NordiNet® International Outcome Study. [ONLINE] Available at: https://www.ncbi.nlm.nih.gov/
pmc/articles/PMC5633042/ [Accessed 1 September 2020]
patients/growth-journey-.html/ [Accessed 1 September 2020]