Many parents worry that their child is too short or too thin; others worry that their child or is too tall or has put on too much weight. However, some children are naturally smaller or bigger than average, and serious disorders affecting growth are rare. The best way to avoid unnecessary anxiety is to keep a regular record of your child's height and weight so that you can check that his or her growth rate is within the normal range. Consult this chart if your child is losing weight or is gaining weight at a much slower rate than you would expect, or if your child fails to grow in height as much as expected.
1Are you mainly concerned about your child's weight?
Possible cause These symptoms may be due to diabetes mellitus. This condition is caused by insufficient production of the hormone insulin, which is needed by the body to obtain energy from sugar and carbohydrate foods.
Action Your doctor will take a blood sample to check your child's blood sugar level. If the diagnosis is confirmed, your child will probably need insulin injections for life. He or she will be taught how to inject the insulin and monitor his or her blood sugar level. Your doctor will also advise you on your child's diet and lifestyle (seeDiabetes mellitus).
17
Possible cause A serious illness or infection, particularly one in which your child is confined to bed for any length of time, can interrupt normal growth.
Action Make sure that your child is eating a healthy, balanced diet (seeHealthy eating in children). Monitor your child's weight, and consult your doctor if your child does not start to gain weight within 4 weeks.
18
Possible cause An inability to absorb nutrients from food due to a disorder such as cystic fibrosis or coeliac disease, in which the intestine is damaged by a gluten allergy, may be the cause. Consult your doctor.
Action Your doctor will probably arrange for tests. If cystic fibrosis is diagnosed, treatment will include drugs to aid digestion. If coeliac disease is diagnosed, your child will need to go on to a gluten-free diet.
19
Possible cause and action Your child may just be naturally thin. This is particularly likely if at least one parent is also slim. However, you should consult your doctor to rule out a serious underlying cause.
20
Possible cause and action Your child's weight is within the normal range, so as long as he or she seems happy and healthy, there is unlikely to be an underlying medical problem. Monitor your child's growth, and consult your doctor if your child seems unwell or if you continue to feel concerned.
21
Possible cause Overweight children are often taller than average, although their eventual adult height is usually within the normal range. Consult your doctor.
Action Your doctor will probably weigh your child and measure his or her height. He or she may also arrange for tests to look for an underlying cause. However, dietary advice may be all that is needed (seeHealthy eating in children).
22
Possible cause and action Your child is probably just tall for his or her age. This is particularly likely if at least one of your child's natural parents is also tall. If you are concerned that your child is markedly taller than other children of the same age, consult your doctor.
23
Possible cause A serious illness or infection, particularly one in which your child is confined to bed for any length of time, can interrupt normal growth.
Action Your child should start to grow normally again once he or she has recovered from the illness. No specific action is needed, but if you are still concerned about your child's growth, monitor his or her height, and consult your doctor if the child does not seem to be growing as you would expect.
24
Possible cause and action Certain drugs, such as corticosteroids, taken in high doses or over long periods of time can interfere with growth. Consult your doctor. Meanwhile, do not stop your child's prescribed drugs.
25
Possible cause Your child may simply be short for his or her age. This is especially likely if at least one parent is also short. Rarely, poor growth may be due to a hormone deficiency. Consult your doctor.
Action Your doctor will probably need to know the heights of both parents. If a hormone deficiency is suspected as a cause, your doctor may arrange for blood tests and refer your child to a specialist for further tests and treatment.
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Consult your doctor if you are unable to make a diagnosis from this chart.
27
If you cannot make a diagnosis from this chart and are still concerned about any aspect of your child's growth, consult your doctor.
Cystic fibrosis
Sweat testing Cystic fibrosis results in higher than normal levels of salt in sweat. A small, painless electric current is applied to the skin to induce sweating. The sweat is then collected and analysed.
Cystic fibrosis is a genetic disorder in which secretions from the glands are abnormally thick. This results in a range of problems; in particular, thick mucus in the lungs causes a persistent cough and recurrent chest infections. Abnormal secretions from the pancreas interfere with the child's ability to digest food and cause him or her to pass pale, bulky, strong-smelling faeces. Children with cystic fibrosis frequently fail to grow normally and are often underweight. The condition is present from birth but is sometimes undetected for months or years, during which time the lungs may have become damaged. Regular chest physiotherapy performed by a parent, antibiotics, and drugs to aid digestion now enable most affected children to survive well into adulthood.
Family Doctor Health Advisor is for information purposes only, and is designed as a general reference and catalyst to seeking further information.
The RACGP is not engaged in providing medical or other advice or services, and is not responsible for the results of any actions taken by any person on the basis of any information in this publication, or for any error in, or omission from, this publication.
Publication Date: 31 March 2009 Authorised By: RACGP
