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Consider growth retardation in children!
Kilo The child's weight and height development should be closely monitored! En SSK Bakırköy Maternity Hospital Women and Children's Diseases Training Hospital Pediatric Endocrinology and Metabolic Diseases Specialist, Clinical Chief Contact S. Erdal directly warns parents of growth retardation.
: - How to monitor growth? What are the standard values?
Dr. Contact S. Erdal directly Infancy, play, and adolescence are three important periods in terms of monitoring growth. The fastest period of growth is in infancy. The child is 25 cm. grows, the weight folds 3. The second child of the infant, the child 12 cm. grows, weight gain also drops a little more. Until adolescence; ie play age, school age during the period of 4-7 cm. Grow. In the second fast period, in adolescence; Hereditary factors, genetic factors, nutrition and environmental factors, depending on the impact of growth is triggered. We don't know how puberty begins, it's triggered. In this period, boys total 25-28 cm., Girls 20-25 cm. They stretched. Of course, each child's adolescence is unique. Adolescence of girls starts at the earliest at 8 years of age and 9 years at males. There are studies for Turkish children; 10 years for girls and 11-12 for boys.
8 cm per year for girls and 9-10 cm for boys. growth must be at stake. The growth rate of girls slows down when menstruation begins. Bone age can be monitored on wrist radiographs in girls; The ossification is closed with the effect of the hormone estrogen, and the pace of growth slows down rapidly. After starting menstruation, the girls should be 5-7 cm. they can grow longer.
: - How to identify growth retardation?
Dr. Contact S. Erdal directly The family can monitor the child's growth according to height and weight gain. If there is no improvement in the standards we have mentioned, things are not going well. 'He has attracted to parents' or 'uncle, aunt has attracted' he can not ignore.
First, until adolescence, the average annual growth of less than 4cm. Necessarily consult a pediatrician. Once a year, the child should be taken to a doctor and the growth curve should be checked.
Here, many criteria should be taken into consideration, from the mother's pregnancy to the birth history, from feeding during pregnancy to the way the baby is born. Ex; Breech-born babies, premature babies, low-weight born babies should be followed. Standard growth charts for Turkish children are available. We take these into consideration and evaluate the growth of children.
: - To what extent is growth retardation caused by growth hormone deficiency? How is it diagnosed?
Dr. Contact S. Erdal directly Eighty percent of children brought to pediatric outpatient clinics due to growth retardation are normal, which includes familial short stature or short stature caused by structural growth delay. The remaining 20 percent are pathological causes. At this point; maternal pregnancy, down syndrome, turner syndrome, silver-russell syndrome can also cause growth retardation in the child. Congenital heart diseases, asthma, allergy, poorly controlled diabetes, inflammatory bowel disease, thyroid deficiency are the factors that affect the growth of the child.
To check if there is any chronic disease that prevents growth; Before we do a number of investigations. Urine analysis, anorexia, fecal analysis against any parasites that may cause developmental delay, allergy tests, respiratory tests are performed. If there is any chronic condition that prevents growth, the cause is determined and treated and ruled out. If a disease lasts more than two years, it affects growth. Stunting, constriction may be caused by chronic diseases that prevent growth. A hand wrist radiograph. The patient's bone age is checked. And whether the problem is familial short stature, structural disorder or pathological problem is decided.
If the child grows less than 4 cm per year, if the bone age is less than 2 years compared to the calendar age, if the parent is long but there is shortness in the child when compared to the parents, then growth hormone deficiency can be mentioned.
: - How is growth hormone deficiency diagnosed?
Dr. Contact S. Erdal directly Diagnosis is made by performing two growth hormone stimulation tests. There are specialized centers, these tests can only be done here. Levels of growth hormones are measured. Below certain values, growth hormone deficiency can be mentioned. To exclude a cerebral pathology, we perform a brain MRI showing the region of the growth hormone, the hypothalamus and the pituitary. If there is no evidence of a tumor or a pituitary gland cut, we can diagnose ideopathic growth hormone deficiency of unknown origin. If the wrist radiograph gives negative results and the patient does not grow, the diagnosis is made and growth hormone can be started.
: - What is the role of growth hormone in treatment?
Dr. Contact S. Erdal directly Growth hormone; Until 1985, it was obtained from the pituitary glands of cadavers. It was the case with all endocrine diseases. Then, some viruses and neurological findings were found and banned all over the world. Today, the treatment uses drugs that are produced with recombinant technology, which are equivalent to human growth hormone, and do not have any side effects. These patients are socially protected. So; drugs used in this disease are paid by the state.
Growth hormone deficiency 10-12 cm in the first year after starting treatment. growth is seen. These children average 1 cm each month. They grow. In the second year, 7-9 cm, in the third year 6-7 cm. They stretched. Apply this medicine before going to bed at night. Because; growth hormone is secreted during the deepest period of sleep. The place of growth hormone drugs in treatment is very important.
: - In which situations should families be alert and alert?
Dr. Contact S. Erdal directly For early diagnosis; it is very important to consider the following symptoms. Typical symptoms in infants or children with growth hormone deficiency; mature human face, thin voice, short stature, abdominal fat, micropenis in boys, prolonged jaundice, low blood sugar in the newborn period, dislocation and a wide forehead.
Since we are one of the central hospitals, we see a lot of patients. However, in general, the incidence of growth hormone deficiency is 1 in 4 thousand.
The sooner the diagnosis is made, the less the height loss of the patient. But in general; Because it is noticed during adolescence, the age of starting growth hormone treatment is too late. At the age of 10-11, with the warning of the environment, it can be noticed that there is no growth. The patient is wasting time.
: - How long should the treatment continue?
Dr. Contact S. Erdal directly Growth hormone therapy; until the ossification points are closed. Growth hormone has some effects other than growth. Antidepressant, reduces osteoporosis, strengthens bones and muscle development. When the treatment is finished, there may be some problems caused by the discontinuation of this hormone. Growth hormone in children growing up, when it comes to adulthood depression, sleep disorder, bone resorption, etc. problems. At this point, it is necessary to transfer the patient to adult clinics because the patient is still required to follow up. If necessary, it is necessary to continue to give low-dose growth hormone. So; The patient, whose treatment is completed in pediatric endocrinology, needs to be followed in adult endocrinology.
: - Is there dwarfism when it comes to growth retardation? Is there a relationship?
Dr. Contact S. Erdal directly Dwarfism is a general definition. There are many reasons, not just due to growth hormone deficiency. A number of skeletal disorders, familial short stature, thyroid hormone deficiency, Down Syndrome, Turner Sandromu, severe nutritional disorders, vitamin deficiency such as… Growth hormone is used if necessary depending on the cause of dwarfism treatment.