Common Growth Concerns:
How Short is Too Short?
You are dropping your child off at school and notice him or her standing among several peers of the same age laughing and playing together before school starts. But, something is slightly different about your child when compared to their peers, they are significantly shorter than everyone else. As a parent, it’s hard not to start worrying about your child’s growth right away. You also don’t want them to be teased by other kids for being different, you know kids can be brutal. But, how do you know if there is a real problem? How short is too short for a child of a particular age?
How Height Works
The first thing to understand when trying to evaluate if your child is too short is to learn a bit about height and growth work. Children grow at different rates and have growth spurts at different times. These “growth spurts” can result in a major discrepancy in height between two peers of the same age. So, your child’s height may be normal, they just haven’t hit their growth spurt. But, it’s hard not to worry especially if they are a lot shorter than all of the kids in the class. Before jumping to conclusions, more information is needed to determine if there truly is a problem with growth.
Growth rate and height are determined by two main factors: genetics and the environment. Genetics are extremely influential, about 60-80% of the differences in height are due to genetics. If the child’s parents are short or were slower to grow as children, the child may also be shorter than their classmates or their timing of growth may be slightly slower. Neither of these indicates a problem, the child is just following their individual growth pattern pre-determined by genetics. There is not much that can be changed about genetics, two parents who are short are unlikely to have a child tall enough to be a professional basketball player, although it can happen. Also, take into account that many kids who are short for their age during a certain period of their childhood do end up ultimately catching up with their peers at their own individual rate.
Environmental factors can also play a role in determining a child’s height and growth pattern. Nutrition, sleep, stress, and medical conditions can all have an effect. A balanced diet, including enough calories and protein, is essential for growth. A lack of certain nutrients such as calcium, iron, zinc, vitamin A, and vitamin D may also impact growth. Lack of sleep can prevent a child from growing to their full potential because during sleep is when growth happens. Too much stress also stunt a child’s growth because the body is too busy trying to manage the stress to grow properly. Lastly, medical conditions and illnesses can affect a child’s height and growth patterns. Any conditions that may be affecting growth can and should be diagnosed and treated by a pediatrician. But, if you child has an adequate diet, gets enough sleep, and has no other major health problems or stressors, how do you know if they are too short?
How Short Is Too Short?
The way to determine if a child is too short is to use a standardized growth chart. The Centers for Disease Control and Prevention publish these clinical growth charts to help health practitioners quickly assess a child’s growth. These charts compare a child’s height to an average growth pattern for a child of their age and sex, so you can get a quick assessment of where they fall when compared to their peers. Each line on the growth chart indicates a certain percentage of the population that would be that particular height at a particular age.
Generally, a child of short stature is defined as falling below the third percentile on the growth chart. This means that for every 100 children of the same age, only three will be shorter than your child and 97 will be taller. Another way short stature is defined is that the child’s height is two standard deviations below the average height for their age and sex, which is probably more complicated to figure out than to simply plot the child’s height on the growth curve.
Most children start at a particular percentile and grow along their own individual curve with few fluctuations. For example, if they are in the 25th percentile, they remain in the 25th percentile until they reach an adult height. There are some exceptions to the rule, for example when children start walking they tend to lose a little weight and drop a percentile or two. This is not a problem as they usually catch up once their bodies adjust to the increase in activity. Some children are a bit slower at growing, and that is okay! They might have a growth spurt a bit later and continue to grow once other children have stopped growing. This also may indicate that they will enter puberty later as well.
If your child is below the 3rd percentile for their age, doesn’t always indicate a problem, particularly if they have always been at a lower percentile. Children who were born premature or are genetically predisposed to being smaller, can still be healthy at a shorter height. Suddenly jumping up to a much higher percentile or dropping to a lower one is a cause for concern that needs to be addressed. When this is the case, many children can receive appropriate treatment and continue to grow to a normal height, particularly when the problem is addressed early.
What Causes Short Stature?
There are four main causes of short stature:
1. Idiopathic short stature - This is when there is no specific cause for the short stature, but the child is healthy with no other medical conditions.
2. Constitutional growth delay - Some children simply develop later than others, but usually catch up by adulthood. These types of children are referred to as “late bloomers."
3. Genetics - Up to 80% of height differences are determined by genetics. If one or both parents are short, it is likely they child will also be short.
4. Medical condition causing delays in growth - There are many medical conditions that can influence growth caused by hormonal issues, digestive problems, bone diseases, or genetic disorders. Your pediatrician can help diagnose any of these conditions and determine the best course of action for treatment.
When To Be Concerned
Being shorter than one’s peers is one indication that there may be a problem with growth. Another way to assess if there is a problem with growth is to use a child’s clothing as a way to gauge if they are growing properly. Typically, a child will grow two to three inches a year, so if they are still wearing clothes from last year and they are fitting comfortably, this may be a problem.
If your child is shorter than their peers and they are still in clothes from a year ago, you may want to take them to see their doctor. Only a doctor can determine if short stature is an indication of a bigger problem and if it is due to an underlying medical condition that needs treatment.
Most doctors will first do a full assessment of the child’s growth pattern. This will include measuring their height, weight, body mass index, and head circumference. They will also try to determine how well they are reaching their developmental milestones for their age. In this assessment, the doctor will be focusing on growth velocity and patterns. The child should be growing at a steady rate every year. They will also be looking for any drops in percentiles for height, weight, or body mass index on the growth curve, which may be a warning sign.
The pediatrician should also ask about the child’s diet, sleep patterns, and any significant stress the child may be experiencing. They will take into account the height and growth pattern of both parents to assess for genetic factors that may be causing delays in growth. If you know your own personal growth pattern as a child, this would be valuable information to the doctor. They may ask about family medical history, any history of genetic disorders, as well as information about the child’s birth and the mother’s health during pregnancy. Be sure to be prepared to answer a variety of questions to help the doctor get a full understanding of your child’s health.
Depending on what is determined during this visit, the doctor may order more tests for medical conditions that could be causing stunted growth. Some of these tests may include an X-ray, hormone levels, a complete blood panel, or a DNA analysis. Possible issues they may be looking for could include chronic illness affecting the organs, inadequate nutrition, significant stress, insufficient production of hormones, or genetic conditions that affect growth.
Once all the tests are evaluated the doctor will help determine the best course of treatment. For many conditions, the earlier these problems are identified the more likely the growth delay can be treated. Some of these illnesses can cause permanent short stature or delayed growth, but these conditions are generally rare.
How Can I Help My Child?
If the doctor does diagnose your child as being too short for their age, the first step is to address any underlying medical conditions that may be the cause. But, if that has already been addressed or there is no major condition causing the short stature, there are a few things that can be done to help them catch up.
First, make sure they have a well-balanced diet that includes adequate calories to support their growth and their activity levels. Most children need three meals and two snacks a day to help meet their calorie needs, since their stomachs do not hold as much food at one time.
In addition to getting enough calories, be sure to include growth-boosting nutrients such as protein, zinc, iron, calcium, vitamin A, vitamin D. Healthy Height™ can help promote natural growth and includes whey protein and growth-boosting nutrients. It has been clinically-shown to promote visible growth within three months when consumed twice a day.
Make sure your child is getting enough sleep. Children need a lot more rest than adults and most should sleep between 10-12 hours a night. A solid bedtime routine, putting them to bed at the same time every night, will help establish a good sleep pattern.
Lastly, address any potential stressors your child may have, if possible. A child who is shorter than his or her peers may struggle with self-esteem or feeling different. Discuss growth patterns with your child and explain how everyone grows at a different pace. Encourage them to see their uniqueness and honor their special abilities. Help them develop their individual talents so they can focus their energy in a positive direction. Emotional support from their family can help them cope with their short stature in a more positive way and relieve stress.
Trying to figure out if your child is too short for their age can be a complicated process, the answer is not that simple. Open communication with your child’s doctor and focusing on the healthy habits you can control such as diet and sleep, can help you feel less stressed about their height. At the end of the day, your child’s health and happiness is what matters most, not how tall they are.
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