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Short girls less likely to have height checked

Girls may be less likely than boys to have their short height checked out for possible medical causes, at least among poor kids, a new study suggests.
/ Source: Reuters

Girls may be less likely than boys to have their short height checked out for possible medical causes, at least among poor kids, a new study suggests.

Researchers found that of more than 33,000 children seen at four urban pediatric practices, short girls were tested for hormone deficiencies only half as often as their male counterparts.

Overall, 9 percent of the study group had so-called "growth faltering," which refers to kids whose height is in the bottom 5 percent for their age and gender, based on standard growth charts. It can also include children who, at some point, show a particular degree of growth "deceleration."

Among the short kids, 0.9 percent of the girls were tested for growth-hormone deficiency, versus 1.8 percent of boys.

Most short children have no underlying problem.

If the parents are on the short side, for instance, it may be perfectly normal for their child to be as well, noted Dr. Adda Grimberg, a pediatrician at Children's Hospital of Philadelphia and the lead researcher on the new study.

In other cases, she told Reuters Health in an email, children are just "late bloomers" who will catch up with their peers when their puberty-related growth spurt arrives. Like height in general, the tendency to be a late bloomer also runs in families, Grimberg noted. So taking a family history can help pediatricians tell which kids with growth faltering are likely to have a later growth spurt.

In some cases, though, slow growth can be a sign of a growth hormone deficiency. It's estimated that 10,000 to 15,000 U.S. children have the deficiency, which can also cause kids to have a young-for-their-age face and chubby body build.

If girls are less likely than boys to have their growth hormone levels tested, Grimberg's team says, then they may also be less likely to have a deficiency diagnosed.

Research from various countries shows that about twice as many boys as girls are on growth hormone therapy. The reasons are unclear, but some have speculated that boys are more often referred for treatment because it is more socially acceptable for girls to be short.

Waiting 'missed the clue'
It's possible, according to Grimberg, that girls in this study were less likely to be tested for growth hormone deficiency because "social pressures for tallness" are greater for boys. But there is no way to tell that from the data, she said.

The researchers also found that 1.4 percent of girls with growth faltering underwent chromosome testing for Turner syndrome -- a genetic disorder that affects about 1 in 2,500 girls worldwide.

Besides short height, Turner syndrome can cause outward signs like swelling of the hands and feet, and excess skin around the neck. It also usually causes infertility and may lead to long-term health problems like kidney disease, high blood pressure, diabetes and bone thinning.

Of girls in this study who were tested for Turner syndrome, 35 percent were age 12 or older -- which is late, the researchers say, because when growth hormone therapy is started at a young age, it can normalize a girl's final adulthood height, and help her start puberty at the typical age.

"Waiting until after age 12 to check chromosomes suggests the pediatricians were investigating the lack of puberty and essentially missed the clue of growth failure in the preceding years," said Grimberg, whose findings appear in the journal Pediatrics.

The children in the current study were seen at inner-city Philadelphia medical practices and were mostly African American and covered by Medicaid -- the government health insurance program for the poor.

It's not clear whether they had generally low rates of growth hormone testing versus U.S. kids overall, according to Grimberg. Past studies on how growth faltering is managed, she said, have focused not on the general population, but on children referred to specialists.

Grimberg said she and her colleagues have a larger study underway to look at how growth faltering is managed in a more diverse population of children.

The current study was funded by the National Institutes of Health. Grimberg has received funds to present her research at meetings sponsored by growth hormone makers Pfizer and Novo Nordisk.