Q: Please help a distraught mother with a problem that won't go away by itself. My 7-year-old son is very short, and his height is causing his father and the rest of the family great anguish. Our doctor keeps trying to reassure us, but we have heard of cases where a new growth hormone has made all the difference in the world. Where and how do you get it if your own doctor won't help? Please point us in the right direction.
A: There are many factors to consider in answering your question and, unfortunately, you have not provided me with much information. Let me give you a few facts, however.
Though there are about 15,000 children in the United States who are "short" because of the lack of growth hormone, twice that number are referred to specialists for evaluation. On the level of family doctors, the numbers are many times higher than that. Yet not every small child is truly "short," and in fact there are no working definitions to help us define short stature.
Often parents try to compare their children with others in their class or group, yet the wide variance in the normal range means that every short child is not really abnormal at all. And in many cases, short stature is not due to the absence of enough growth hormone. That may be the reason your doctor is trying to reassure you. A child can be in the lower portion of normal because of family characteristics, overall health and nutrition.
As important as the actual height is, the rate of growth is more important in evaluating the status of a child. This is established by careful measurements of height taken at regular intervals and plotted exactly on a growth graph. If the growth rate is less than two inches per year in a child who is 3 to 12 years old, a preliminary evaluation for abnormal growth is in order.
Not all growth disorders are due to hormone deficiency, so studies to determine undetected heart disease, liver disease, kidney abnormalities and disorders of the gastrointestinal tract may be advisable. If, however, growth hormone deficiency is established as the primary cause, and your family physician is unwilling to assist you, seek the services of a pediatric endocrinologist, who specializes in problems of hormones and growth.
Even if the problem is lack of growth hormone, it will be important for you to gain some understanding of the expected results of treatment. There will be no sudden spurt of growth, nor may your son attain the height you wish for him. The growth rate of a child with a deficient hormone status is about four inches in the first year of treatment and slows down after that. Of course, each child is different.
Finally, there is the matter of cost of treatment and the long term over which it must be continued. Current costs run $10,000-$30,000 a year, and treatment is continued throughout childhood. The medication is administered by injection anywhere from three times a week to daily. There are two products currently on the market, but more companies are seeking FDA approval for competing medications that may lower the price in the future.
Synthetic growth hormones have been on the market for but a short time, during which their safety record has been exceptional. However, the long-term effects of this therapy have yet to be determined, and any decision to begin such treatment should follow a full understanding of all the implications.
Q: My oldest son, age 11, seems to delight in snapping his shoulder in and out of place with loud pops that scare the bejingos out of me. He proudly explains that he is "double-jointed" and his father encourages him. I want him to stop because I fear he is doing himself irreparable harm. Could you please take the time to comment on this? There must be other mothers with joint-cracking kids who need some help.
A: There really is no such thing as a "double joint" -- that would imply that a joint can flip freely back and forth. The closest thing to such an action is the free movement permitted by the ball joint and sockets that form the shoulder and hip. Part of our language is the development of descriptive terms, and "double-jointed" refers to people who have long or very flexible ligaments. Because these ligaments fail to tie the bones that form the joint together tightly, these children can pop their shoulders and fingers in and out of their sockets with great ease and no pain. When they move the joint back into place by contracting the proper muscles, a loud snap or pop, which can startle an unaware mother, can be heard.
Ligaments can be stretched through training, as in the case of certain acrobats and circus performers, and good exercise technique requires a stretching period to loosen tightened ligaments and promote greater flexibility. Hormones can affect the firmness with which ligaments hold joints together. During pregnancy the hormones at work in a woman's body help loosen the ligaments that form part of the pelvic ring, permitting it to open to permit the baby to pass through. Loose ligaments seem to run in certain families and may have a genetic basis, at least in some cases. However, none of these situations is considered abnormal.
While overly loose ligaments pose no threat to health, constantly popping the joints in and out over the years can lead to soreness in the joint, unwanted dislocations of the joint and an increased risk for arthritis.
Dad, once or twice this could be considered "cute," but overdoing it may hold unwanted results in the future. Give Mom a break and help her break your son of an unnecessary and annoying habit.
Dr. Allen Bruckheim welcomes questions from his readers. Although he cannot respond to letters individually, he will answer questions of general interest in his column. Write to him in care of The Buffalo News, P.O. Box 119, Orlando, Fla. 32802-0119.