“My daughter is extremely short for her age. What should I do?”

Not quite enough information provided to answer your specific question. Missing information would include actual height and weight plotted on a standard growth chart, specific height and weight of both parents as well as growth information about siblings, height and weight information about aunts, uncles and grandparents since that would give some "genetic" guidance as to what might be expected. Also, usually after a detailed past medical history, detailed review of systems and detailed physical exam,including Tanner staging now and previously, all these would then allow some possibilities to be considered. Conditions such as Noonan Syndrome, Turner Syndrome and other more rare genetic conditions that are associated with short stature and/or growth deceleration also should be considered with specific genetic testing ordered if there is some suspicion by history or exam or both. If nothing is obvious with that detailed patient and family review review by your primary care provider, then some nonspecific screening blood work and urine testing (urinalysis) is usually the next
step including complete blood count and sedimentation rate, transglutaminase celiac antibody test, thyroid tests (free T4 and TSH) and IGF-1 levels as well as general chemistry screening test (glucose, kidney tests BUN and creatinine, liver tests SGOT, SGPT, calcium, phosphate, albumin and electrolytes sodium, potassium, bicarbonate and chloride), Thyroid and celiac tests often do not have obvious clinical evidence but sometimes only decreased height velocity/short stature and concomitant excess weight for height.
The only other "screening" test would be a simple left hand xray bone age determination; when combined with the other items, this often leads one to more specific testing such as skull xrays of the pituitary region, brain CT or MRI studies etc. Consultation with a pediatric growth specialist, endocrinologiste, usually can help sort out these considerations and help decide if more specialized growth hormone or other hormone testing might be needed.

You may visit an endocrinologist to examine her bone age. She could be a late bloomer.

Growth is affected by genetics, nutrition, physical, and psychosocial and hormonal factors. Besides genetic endowment and hormones, poor nutrition, and psychological or psychological deprivation can stunt (restrict) growth. Loving care make children grow better than keeping them in orphanage. in other words institutionalized children thrive less than children in loving homes. Nutrition is also the whole mark of maximum expression of the gene for a better growth. During the American civil war the average man was about 5 feet 2 inches. At this time, the average man is about 5 feet 10 inches. The gene does not change in 150 years. What has changed is nutrition. The better the nutrition is the better the growth. Similarly children who are small and picky eaters are generally small due to sub-optimum nutrition.
Hormones also play a very important role in growth. Growth hormone and thyroid hormone are prime examples. Other hormones given in excess amount or produced in excess can cause growth restriction. excess cortisol is an example. Numerous genetic abnormalities can also interfere in growth. examples will not be discussed here because they are beyond the scope of this topic. Gastrointestinal conditions such as celiac, inflammatory bowel disease can lead to growth failure. Anemia, liver disease, kidney disease, heart disease will also stunt growth. There many other medical conditions that will interfere with normal growth as well. In your daughter's case, there is no simple answer to your question without proper medical evaluation of your daughter. She needs to have proper evaluation to exclude turners syndrome, skeletal dysplasia's growth hormone or thyroid hormone deficiency and other hormonal and medical problems. You can optimize his nutritional intake. you can also see a nutritionist if you think his nutritional intake is in question. Make sure you also pay attention to his weight. You do not want to create obesity in trying to promote his height growth.
Regarding hormone supplement, she needs to see her doctor to determine if she needs hormone therapy after a proper work-up. If your doctor determines there are hormone imbalances, the doctor will do what is appropriate to help her achieve the genetic potential.
Good luck.

Evaluation by an endocrinologist.

Growth in kids is one of the most important signs of health. In order to have an appropriate growth a multitude of organs in your body must be working in perfect synchronicity. The best that you can do for your daughter is to take her to a pediatric endocrinologist as soon as possible who will calculate her mid-parental-target height, check her growth chart, perform a comprehensive physical exam, order some blood work and a bone age X-ray. Once the doctor has all the pieces of this puzzle, he/she will be able to give a more precise answer about her growth.

If a child is growing below his/her genetic potential or not growing at least 2 inches a year, after 3 years and before puberty should be evaluated by a pediatric endocrinologist.

Make sure that your daughter is getting plenty of sleep (8-10 hours per night). Growth hormone is produced mainly during deep sleep. Also, make sure she is eating a balanced diet. Also, ask her primary care provider to do an evaluation and possibly refer her to a pediatric endocrinologist.

Short stature is often a familial pattern, so a large degree of genetics involved. Most important if this is not an obvious family pattern, would be to have a complete physical examination and detailed systems review. Conditions like Turner and Noonan syndrome can be associated with short stature and both respond to growth hormone treatment very well. Some other genetic conditions also are associated with short stature. Other problems such as thyroid, adrenal, pituitary and hypothalamic difficulties need some evaluation usually by lab testing and most often with consultation with a pediatric endocrinologist experienced in these ares. Celiac disease also sometimes presents not only with stomach and gastrointestinal complaints, but also short stature and there is a simple blood test to screen for this as well. The key is looking at growth data, evaluating this information with a
thorough exam and history, and then getting appropriate X-rays and blood work to try to determine the cause. Should be evaluated by your primary healthcare provider, and then ask about a consultation with the nearest pediatric endocrinologist.

Stuart Brink, MD