What it is
Growth and puberty are controlled by hormones, including growth hormone, thyroid hormone and the sex hormones. When these are out of balance, a child or teenager may grow too slowly, or start puberty earlier or later than expected.
Concerns include:
- Short stature or slow growth compared with children of the same age and with the parents' heights
- Early (precocious) puberty: signs of puberty before about age 8 in girls or 9 in boys
- Delayed puberty: no signs of puberty by about age 13 in girls or 14 in boys
- Hormonal causes, such as growth hormone deficiency, an underactive thyroid or excess cortisol
Many children who are short or develop late are healthy and simply follow their family's pattern. A proper assessment identifies those who need treatment, ideally before growth is complete.
Common symptoms
- Growing noticeably more slowly than classmates, or dropping across lines on a growth chart
- Being much shorter than expected from the parents' heights
- Breast development, pubic hair or periods before about age 8 in girls
- Pubic hair, testicular enlargement or a breaking voice before about age 9 in boys
- No breast development by about 13 in girls, or no testicular growth by about 14 in boys
- A growth spurt together with early signs of puberty
When to see a specialist
- Your child is much shorter than peers, or their growth has slowed
- Signs of puberty appear earlier than the ages above, or are much delayed
- Periods haven't started by about age 15
- Your child has a long-term illness or has taken steroids, and growth is affected
- A doctor has noticed abnormal growth on a growth chart
Treatment and management
- Growth assessment: accurate height measurements over time, compared with the parents' heights and growth charts
- A bone age X-ray of the hand, and hormone blood tests
- Treating the cause, such as thyroid hormone replacement
- Growth hormone or puberty-related hormone treatment for suitable children, with specialist monitoring
- Coordination with paediatric specialists where appropriate
How an endocrinologist helps
Dr. Marium Zaman assesses growth and puberty in light of family pattern, general health and hormone tests, explains to families whether the pattern looks normal or needs treatment, and arranges follow-up or referral to paediatric endocrine services when needed.
