growth suppression

December 27, 2010 at 6:24 am

Steroids definitely can suppress both weight and height growth as can serious illness. I have definitely seen loss in both height and weight growth associated with steroids and one needs to think about the dose and the schedule of administration if this is occuring and also to think about other reasons that a child might not be growing as well. If the MRI is of the brain, this will include the area that controls hormone production (pituitary). Anyone having one autoimmune problem (like CIDP) has a slightly greater chance of having another autoimmune problem (like low thyroid or intestinal problems) and so thyroid and growth hormone (IGF3 is the blood test) should be checked. It would also be good if he has a few other tests of general body function–such as looking at the salts in his body (electrolytes) and indicators of liver and kidney function (chemistries) by a chem23 or CMP (comprehensive metabolic panel) just to make sure that these are not off enough to affect growth and also that changes in them may give insights into what might be affecting growth. Typically we also do a CBC as well and a urinanalysis for growth failure.

To answer the question about percentages, he is definitely less than the 5% now in height and weight and birth weight was 50-75%. More importantly, you say that the fell off “his curve” when he got sick. Check and see if he is now growing on a new curve–this is a little less concerning than not growing. You say that he has not gained any weight in a year and this is not growing. If his height percentage and weight percentages are falling, this absolutely needs to be investigated by the pediatrician, one of his specialists, or an endocrinologist. It is really important for children to grow; to not be doing so indicates that something else needs attention–especially if the height percentage falls or the head circumference percentage falls (especially in little kids).

It is important also to say that the curves are important not just one or two points in time. Kids can fall behind because of illness but grow along a new curve and may eventually catch up again. This is not as worrisome as falling off the curves from no growth at all, but it is still important to watch carefully. My area is helping children with cancer and blood problems and we often see a “temporary” drop in a growth curve with the diagnosis of cancer and treatment, but kids will continue to grow on a new curve. If not, it needs to be investigated well and corrected if possible.