What syndromes give children mega rapid growth. E34.4 Constitutional tall stature

General provisions . There is no generally accepted definition of the concepts of “excessive growth” and “giant growth”. The data cited by some authors does not take into account the height of the parents, which in some cases is of decisive importance in clarifying the question of the presence of a pathological process. If the child's height is 1.5-2 standard deviations greater than the expected average height (taking into account the age of the child and the height of the parents), further examination is indicated to exclude a pathological process. The influence of acceleration, which parents often consider the first reason for the increased growth of their child (“the child is growing by leaps and bounds”), is overestimated.

Constitutional tall height. In families where children are constitutionally tall, in addition to the fact that the parents themselves are above average height, there are other tall relatives. Body length is determined by numerous genes, so it is not surprising that due to the accumulation of genetic factors that favorably influence growth, children tall parents grow even more.

The concept of "selection" is reluctantly applied to people. However, it is believed that tall women determine the selection of partners.

Children's body length at birth is above average and approximately parallel to the 97th percentile. Standard deviations from the average values ​​do not change significantly. The differentiation of the skeleton is within the limits of normal fluctuations, and since the growth rate is greater, an increase in body length occurs to a certain extent, which worries parents, especially during the pubertal period of accelerated growth. The children are healthy. No endocrine disorders could be detected. Posture disorders are more common, and in girls - motor disharmony, aggravated by stiffness of movement. During the maximum pubertal growth acceleration (at approximately 12 years of age), orthostatic dysregulation becomes more frequent. Due to excessive growth, the well-being of many girls is significantly impaired, which is primarily due to the attitude of others. Boys of the same age, since the pubertal growth spurt, often differ even more from their peers, and from the point of view of growth physiology, they are 2 years younger. Thus, unusual differences in growth rates occur among 12- and 13-year-old students in mixed school classes. Dressing these teenagers is becoming increasingly difficult because sizes are trendy. clothes are aimed at average performance. Sometimes it should be questioned whether the psychological difficulties of excessively tall girls are as great as their mothers indicate, since the latter often project onto the behavior of their daughters the difficulties that they once had in adolescence.

"Constitutional acceleration of development", or early normal puberty. While the manifestation of constitutional retardation (see p. 186) is now well known, it is rarely suspected that almost as often it can occur within the framework of physiological fluctuations early development with acceleration of skeletal differentiation and growth already in childhood. In this case, puberty begins earlier and growth ends earlier (about differentiation with premature puberty). These somewhat taller, early maturing children are not paid attention to and are almost never shown to the doctor, turning to him only in case of simultaneous familial tall stature, which is reminiscent of the fact of treatment in case of more frequently observed familial short stature. The prognosis for bone age is relatively good.

Endocrine diseases and gigantism. 1. Pituitary gigantism, or infantile acromegaly. This extremely rare disease in childhood is associated with autonomous or excessive production of somatotropin-releasing factor (GH-RH), as well as secondary (or primary) eosinophilic adenoma of the anterior pituitary gland. In most cases, high growth is combined with symptoms of acromegaly. Due to the rarity of this disease, it should be taken into account in the differential diagnosis only in cases where there is no family history of tall stature or obvious symptoms of acromegaly are present. It has not been established whether diabetes mellitus develops more often in young patients with acromegaly. Plasma GH levels are elevated and do not decrease (as normal) in response to glucose infusion.

2. Hyperthyroidism. Hyperfunction of the thyroid gland may be accompanied by excessive growth and accelerated differentiation of the skeleton; other symptoms are decisive in the differential diagnosis.

3. Pubertas praecox, pseudopubertas praecox. Characteristic and decisive in the differential diagnosis are a pronounced advance in bone age with a not so strong acceleration in length growth, premature appearance of sexual characteristics and closure of the epiphyseal zones, ultimately leading to short stature.

Chromosomal aberrations. Klinefelter's syndrome. Tallness becomes noticeable only during the slow course of puberty. During the examination, attention is drawn, as in no other case, to the small and often dense testicles.

2. Other sex chromosome abnormalities are not noticeable at first because of increased body length, but later the height of adult patients increases in most cases.

Clinical syndromes characteristic of gigantism:

Marfan syndrome. This is a pathology of connective tissue (mesoderm) of unknown etiology to date.

Genetics. Autosomal dominant inheritance; 15% of new mutations are noted.

Symptoms 1. Tallness: Patients with Marfan syndrome tend to be unusually disproportionately tall. The tallest patient recorded was 7 feet (213 cm).

2. More important sign Than high growth, there are characteristic skeletal changes:

A) shift in body proportions - the ratio of the length of the upper body segment to the lower one is shifted towards the latter, i.e. the ratio is reduced;

B) the ratio of length to width of tubular bones, shifted towards length, increasing the so-called metacarpal index. It is determined as follows: using an x-ray of the hand, the ratio of the length to the minimum width of the II, III, IV and V metacarpal bones is determined, the average value of these 4 numbers is calculated, which normally ranges from 7 to 8; if the index is greater than 8.5, there is a reasonable suspicion of the presence of Marfan syndrome;

B) arachnodactyly, which manifests itself, in particular, when covering the distal part of the forearm. If the patient can put it down thumb near the terminal phalanx of the small, there is a suspicion of the presence of Marfan syndrome;

D) scoliosis, funnel chest, chicken breast;

D) insufficiency of the supporting apparatus of the lens, its trembling, subluxation or spherical lens with severe myopia; high risk of retinal detachment;

E) other mesenchymal symptoms: hyperextension of joints, aortic insufficiency. A dissecting aortic aneurysm is possible. Emphysema and spontaneous pneumothorax additionally indicate the presence of Marfan syndrome.

Differential diagnosis. Homocystinuria may resemble Marfan syndrome primarily in ophthalmological symptoms, but here we cannot talk about phenotypically completely similar diseases. The detection of increased urinary excretion of homocysteine ​​is of important differential diagnostic significance.

Treatment. For exceptionally high expected growth or changes in the spine, treatment with estrogen is indicated, and in boys, testosterone.

The prognosis depends critically on cardiovascular symptoms.

Literature. If Marfan syndrome is suspected, it is recommended to review the extensive information presented by McCushick. It is simply impossible to do without his monograph if there is an assumption about the presence of erased forms of the disease.

Sotos syndrome. High growth with availability common manifestations non-progressive cerebral symptoms and craniofascial signs. Accelerated growth in length, enlargement of the head, and often skeletal differentiation begin at birth.

Genetics and pathogenesis are unknown.

The frequency is low, but due to the lack of accurate data on the geographical pattern of the disease, it may be higher than expected.

Symptoms Tall, macrocephaly with partially acromegaloid features, often intellectual underdevelopment. Mild hydrocephalus and, accordingly, expansion of the ventricles of the brain (not caused by pressure). Sometimes there are cerebral seizures. A typical change in the facial skeleton, along with mild acromegaloid symptoms (without increased GH production), is characterized by an antimongoloid position of the eyes, as well as hypertelorism. In most cases, skeletal maturation is clearly accelerated. The final height is at the upper limit of normal. As for the neurological status, the most precise movements are impaired.

Differential diagnosis. It is possible to distinguish Sotos syndrome from early maturation observed with hydrocephalus of the third ventricle, when only accelerated skeletal differentiation occurs without premature appearance of sexual characteristics, only on the basis of determining the level of gonadotropins or sex steroid hormones in the plasma. However, often the changes in the facial skeleton are so distinct that the diagnosis can only be made using physiognomy.

Treatment. As a rule, the cerebrospinal fluid pressure is not increased. Due to the fact that the final height does not exceed the upper limit of normal, there is no need for hormonal therapy.

Forecast. There is no information regarding the further development of the patients. The general consensus is that cerebral changes do not progress.

Treatment of constitutional gigantism in girls. Mechanism of action. In 1962 and 1963 Whitelaw et al reported successful treatment of tall stature with estrogens. This method was initially introduced only for the treatment of pre-pubescent girls. Meanwhile, it has been shown that it can be successfully used even after the onset of puberty. The effect of estrogens on growth cannot be explained from any one point of view. There are two didactic positions.

In addition to the reduction in expected final height in adrenogenital syndrome or pubertal syndrome, estrogen-induced premature onset of the pubertal growth spurt means earlier closure of the epiphyseal zones. If this happens 2 years earlier, then the theoretically predicted growth decreases by the increase in body length that would have occurred during these 2 years, since the factors influencing growth act 2 years less.

Estrogens influence skeletal maturation while having relatively little effect on length growth. However, with later treatment after the maximum pubertal growth acceleration, estrogens also negatively affect length growth. Based on the latest research, it becomes obvious that along with the acceleration of skeletal maturation, and therefore the earlier closure of the epiphyseal growth zones, the introduction of estrogens also has a negative effect on the growth process itself. When treated with high doses of estrogen, the level of somatomedin in plasma is significantly reduced. At present, it can be assumed that in this case we are talking specifically about the suppression of the secretion of this humoral growth factor by high concentrations of estrogens.

According to the first hypothesis, a decrease in final height is achieved by an earlier course of sexual development. The second hypothesis indicates inhibition of the growth process due to a decrease in the effect of somatomedin while simultaneous estrogen-induced acceleration of the closure of the epiphyseal zones.

It has long been controversial whether the magnitude of final height can be influenced after the onset of puberty, when the chance to accelerate the onset of maturation has been lost. Prader, Birich and our group were able to unequivocally confirm this possibility. The discrepancy between Whitelaw's observations and more recent data may be explained by the different dosages of estrogens used. Whitelaw often used high doses of estrogen - 30-60 mg of estradiol per month, although this is a very weak estrogen, which roughly corresponds in effect to estrogen conjugates. Consequently, Whitelaw used estrogens in doses that corresponded to 1.5 mg of commonly commercially available estrogen conjugates per day. Biric, who managed to obtain good results also when starting treatment already during puberty, used five times daily doses. The doses used by Biric correspond approximately to equivalent doses used with success by other authors after the onset of puberty.

The possibility of treatment with relatively small doses of estrogens before the onset of puberty has been clearly established, but the responsibility for possible psychological complications associated with artificially induced premature onset of puberty should be recognized. After the onset of the physiological course of puberty, in accordance with the treatment methods currently used in most cases, approximately a fivefold dose is required. One can hardly expect psychological problems.

Carrying out treatment. It is not the intention here to fully explain various schemes treatment. The "Pediatrics Manual" presents the technique used by Birich. Our group uses conjugated estrogens before the onset of puberty in average doses of 1.25 mg/day, but after a few months this dose increases by 2-4 times. At a later start of treatment, when the endogenous production of estrogen is already obvious, treatment is carried out with ethinyl estradiol (0.5 mg / day), from the 20-25th day a gestagen is added, and from the 25-30th (or 31st) day break in treatment.

At a panel discussion on the treatment of constitutional tallness at the German Society of Pediatrics in September 1974 in Hamburg, intermittent estrogen treatment (as we do) was considered less justified. Continuous treatment is recommended, which corresponds to the technique proposed by Prader and Birich.

The discussion about estrogen treatment tactics is discussed here in detail in order to clearly show that there are no uniform recipes for the treatment of constitutional tallness. However, the treatment regimen with conjugated estrogens indicated by Birich is fully consistent with modern concepts.

Treatment success. The average reduction in actual final height compared to expected is 4-7 cm. This average is based on very heterogeneous results from individual observations. The success of treatment in each case is definitely unpredictable. However, data from the Zurich working group indicate that growth inhibition is greater the earlier treatment is started after the onset of physiological puberty. Currently, treatment is not recommended before the first signs of maturation appear.

Side effect. It is necessary to distinguish between truly constant or frequently observed symptoms accompanying treatment with theoretically expected consequences. Of the observed side effects Nausea or vomiting at the beginning of treatment, weight gain (4-6 kg), as well as severe pigmentation of the nipples, especially when using synthetic estrogens, should be mentioned. After cessation of treatment, a delay in menstruation is often observed, but this amenorrhea, as observations show, has a short duration (2 - maximum 6 months). Transient lactation is occasionally observed.

No one has yet reported a tendency to thrombosis as a side effect, which should be expected theoretically based on the experience of using drugs that inhibit ovulation. Suggestions that long-term treatment may lead to partial suppression of cyclic hypothalamic functions with impaired ovulation have also not been confirmed. However, Wettenhall and Crauford report normal pregnancy in previously treated patients. Whether treated girls have the fertility seen in the normal population can only be proven on the basis of extensive statistical data.

Treatment of threatened abortion with stilbestrol can cause adenocarcinoma of the cervix or vagina in the child of a mother treated in this way with a probability of 1: 250. To date, the occurrence of tumors in connection with the treatment of tall stature with estrogens has not been observed. Stilbestrol, which has estrogenic activity but is not physiological, is not used, nor is treatment carried out in pregnant women, in whom such side effects may be feared. The associated emotions regarding estrogen treatment for constitutional tallness are unfounded. However, such observations call for caution.

Conclusion. The attitude towards the treatment of constitutional tall stature with estrogens is formed by every doctor who is interested in this based on familiarity with the literature. Participants in the aforementioned discussion were unanimous in the opinion that such treatment is at the stage of clinical trials and should only be carried out by a doctor with the necessary experience and knowledge in the field of endocrinology and growth physiology. Opinions also coincided in that treatment should initially be carried out only in centers that also guarantee follow-up of patients. Various indications for treatment are given. The Hamburg group only accepts girls with a predicted height of 185 cm or more for treatment. Knorr and Stendzik adhere to the same boundaries. Biric considers an expected height of 181 cm to be an indication for treatment. Prader points out that, if certain prerequisites are present, treatment is indicated for an expected height above 175 cm.

The exception to this rule is for us cases with the presence of juvenile scoliosis and significant obvious impairments mental development. In this case, one should take into account the emotionality of tall mothers who would like to protect the child from the problems they experienced in their time. During a discussion at the European Society of Pediatric Endocrinology in Paris, Josso said: "Don't treat the parents."

Treatment of constitutional gigantism in boys. The question of such treatment arises much less frequently than in girls. In accordance with Prader's recommendation, parenteral treatment with testosterone preparations is carried out (initially 250, then 500-1000 mg per month). This results in an acceleration of skeletal maturation and a decrease in predicted final height by an average of 5.4 cm. As Zachmann and Prader point out, there are large individual differences in the effectiveness of treatment. A manifestation of inhibition of gonadotropin production by exogenous sex steroid hormones is a clear decrease in the size of the testicles. According to Prader, normalization occurs within 12-18 months after stopping treatment.

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Tallness is an excess of normal growth rates by more than two points. Growth is programmed genetically and depends on many factors.

This condition may be accompanied by increased fatigue, poor posture, problems in sexual development, and so on.

Causes of tall stature

The cause of tall stature may be a hereditary predisposition. In addition, endocrine diseases can also cause increased growth. In some cases, genetic-chromosomal pathologies are noted. Sometimes tallness is explained by early sexual development.

Constitutional-hereditary tall stature is most often diagnosed in boys. This condition is assessed as normal. At the same time, neither mental nor physical development doesn't suffer. When examining the blood, no significant changes are observed. This is the most common reason tallness.

In addition, increased growth of the child's skeleton can be observed as a result of the presence of a growth hormone-secreting tumor, cerebral gigantism, Beckwith-Wiedemann syndrome, hymicystonuria, untreated congenital adrenal hyperplasia, obesity, as well as increased production of estrogens and androgens.

Symptoms of tallness

The main sign of pathology is high growth, that is, its non-compliance with norms. There are ways to determine a child's future growth. So, for boys it is calculated by the formula: father’s height plus mother’s height, divided by two and plus 6.5 centimeters. For girls, the last digit is minus. Exceeding the normal indicators by two or more indicators is tall.

With increased growth, changes are observed in the vascular and muscular systems. In addition, such people are prone to high blood pressure in the future. In addition, they have a longer recovery period after illnesses.

It should also be noted that high growth causes the child to have complexes. Girls are often embarrassed by their height and try in every possible way to hide it. They begin to stoop, which leads to the formation of spinal diseases. As a result of the fact that the muscular skeleton does not have time to form at the same speed as the bone skeleton, there is a lack of weight compared to height. In addition, given that the heart is also a muscular organ, tall children often experience problems in the functioning of this organ. This manifests itself in the form of weakness, dizziness, heart pain, and so on.

Diagnosis of tall stature

To clarify the diagnosis, parents should be interviewed and determine whether there is a hereditary-constitutional form that does not require any treatment. In addition, an analysis should be carried out to determine the level of growth hormone, amino acids, serum in the urine, glucose in the blood, as well as examinations for hormone levels.

In some cases, tomography, tissue biopsy (if the adrenal glands are affected), radiography, ultrasound, and so on may be required.

Treatment of tall stature

There is currently no specific treatment for tall stature. The use of hormonal drugs can lead to serious side effects, which forces us to abandon this technique.

If the cause of tall stature is concomitant diseases, they should be treated. For example, in case of adrenal tumors, they are removed followed by replacement therapy.

Prevention of tall stature

There is no specific prevention for this pathology. If a disease is suspected, the child should be examined to rule out diseases of vital organs.

Changes in the production of hormones by the adrenal glands result in a variety of health effects. With their excessive activity, puberty occurs faster. If disturbances affect the medulla of the glands, the person develops arterial hypertension. Decreased adrenal function can lead to the development of Addison's disease, or, as it is also called, bronze disease. It is characterized by: skin pigmentation, exhaustion, decreased blood pressure, low sugar levels. With bronze disease, the body's resistance decreases. Dysfunction of the endocrine system can also manifest itself in changes in the activity of the gonads. Hormone production increases, mainly due to the development of malignant tumors. When the functions of the gonads decrease, a disease such as eunuchoidism is diagnosed. This disease manifests itself in excessive growth of the limbs with their abnormal lengthening, the appearance of a tendency towards obesity, underdevelopment of the genital organs and the absence of some secondary sexual characteristics.

Recurrence of a brain tumor (there is no supporting data, and currently this is not given much importance).

Leukemia (seen in children undergoing chemotherapy or radiation therapy; it is unclear whether it increases Therapy, -i; and. 1. A branch of clinical medicine that studies the causes and mechanisms of development of internal diseases, their diagnosis, treatment and prevention. From Greek therapeia - treatment. 2. The totality of diff. conservative methods of treating diseases without surgery. Treatment methods: medications (pharmacotherapy), including antibacterial (chemotherapy, antibiotic therapy) and hormonal (hormone therapy); serums and vaccines (vaccine and serotherapy)

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Metastasis and tumor development (a slight increase in long-term risk of metastasis and cancer has recently been described in surviving children receiving GH; these data require confirmation and their clinical significance remains unclear).

47. Should children with idiopathic hyperplasia (i.e., in the absence of GH deficiency) be treated with growth hormone?

The FDA recently approved the use of srota hormone in children with idiopathic short stature and expected final height.< 160 см у мальчиков и < 150 см у дево­чек. Однако целесообразность такого лечения в отсутствие нарушений секреции ГР оспаривается многими детскими эндокринологами. Результаты кратковременных исследований, включавших небольшие группы детей, свидетельствуют об увеличе­нии скорости роста при лечении ГР в таких случаях. Там же, где детей наблюдали до достижения окончательного роста, были получены противоречивые результаты. Од­нако большинство исследователей подчеркивают незначительное увеличение окон­чательного роста, которого можно добиться, к тому же, ценой значительных финан­совых затрат. Таким образом, применять ГР у таких детей можно лишь после деталь­ного обсуждения с ребенком, членами его семьи я опытным детским эндокриноло­гом, хорошо знающим больного.

48. How do growth dynamics differ in children with an excess of glucocorticoids and with exogenous obesity?

With an excess of glucocorticoids, both iatrogenic (often) and endogenous (rarely), the growth of children slows down. This is due to the direct effect of glucocorticoids on metabolism - stimulation of breakdown and lipolysis and inhibition of collagen synthesis. They also suppress the pulsed secretion of GH by the pituitary gland and the production of IGF-1 by target tissues. All this often leads to short stature in children. In addition, in such children the weight-to-height ratio increases and develops ожирение!}. On the other hand, with exogenous obesity, growth is usually accelerated, and such children are usually taller than their peers.

49. What conditions are characterized by accelerated growth in childhood?

Excessive growth in childhood occurs in a relatively small number of conditions. These include familial tallness (where the child's final height roughly matches that of the parents), constitutional tallness, hormonal disorders and genetic syndromes.

50. What is constitutional tallness?

With constitutional tallness, the bone height is ahead of the chronological height, the growth rate is increased, and sexual development begins earlier than usual; the expected final height in such cases corresponds to the height of the parents. Obesity and heredity may play a role in the pathogenesis of this condition.

Around us there are short, up to 150 cm, and tall, up to 2 meters, women and men. These numbers are in no way related to mental abilities; for us these are variants of the norm. They say that a person’s success and self-esteem depend on height. It is believed that tall women are more ambitious than their short friends, and “short” men compensate for the missing centimeters with a successful career and financial position.

There are those among us who stand out from the crowd. And the parents don’t tall A son may grow to be two meters tall, but with tall parents the daughter will not reach one and a half meters. In adulthood, it is very difficult to influence growth. It is important for parents to regularly measure their child's height. As a rule, dwarfs do not grow more than 130 cm, and giants exceed 2 meters.

Children's growth needs to be closely monitored

Health problems can affect growth: chronic diseases of the respiratory system, heart and blood vessels, gastrointestinal tract, hormonal disorders. Regular use of medications containing hormones, for example to relieve asthma attacks, also slows growth.

It happens that babies who were born with a weight and height below normal grow poorly.

How children grow

1 year of life: + 25 cm.

2nd year of life: + 8-12 cm.

Annual growth: + 4–6 cm.

If during the third year of life the child has grown less than 4 cm, he should be shown to an endocrinologist. Sometimes parents do not pay attention to the fact that their baby is lagging behind his peers in growth, and only realize it when adolescence when it’s already difficult to fix something. If they had contacted specialists in time, they would have helped the child grow up.

Despite the care of parents and proper nutrition, 10% of such children, even after 4 years, lag behind their peers. A similar delay can also occur in those children who have one of the parents below 160 cm. But there is no reason to panic - in most children, doctors find only so-called constitutional growth retardation. There is no pathology, but the child remains the smallest in the class for a long time. As a rule, in such children, puberty begins later - at 14–16 years old: thus, nature extends their growth time. Their parents grew up in much the same way: for a long time they were at the bottom of physical education classes, and then suddenly they grew up and found themselves in the top five. These are boys and girls with late puberty. They do not require any treatment; they will catch up, or even surpass their peers by the age of 16–18.

But in some cases, a special examination - carried out only in a hospital - reveals a deficiency of growth hormone (GH) in the body. GH is produced by the pituitary gland under the control of hypothalamic structures. Its deficiency may be genetically determined or associated with disorders in the endocrine system. Previously, the fate of such children was predetermined; they were doomed to dwarf growth: a boy did not grow above 140 cm, and a girl - 130 cm. Today they can be helped.

FOR CALCULATION FANS

There are formulas that allow you to calculate your child's genetically determined height. Their error is quite large: plus or minus 5–10 cm.

Girls = (father’s height in centimeters + mother’s height in centimeters) / 2 – 6.5 cm.

Boys = (father's height in centimeters + mother's height in centimeters) / 2 + 6.5 cm

What is responsible for growth?

Somatotropic hormone (GH), or the so-called “growth hormone,” is responsible for growth in the human body. Sex hormones of the thyroid gland and insulin are also important, but in relation to growth they are active only if there is a normal level of growth hormone. It turns out that a deficiency of one or more of the listed hormones or an excess of adrenal hormones entails growth retardation and without appropriate treatment the matter will not progress.

Fortunately, endocrine growth delays are detected in less than 1% of children. A real lack of growth hormone leads to dwarfism (nanism): then boys grow no more than 140 cm, girls - up to 130 cm. The sooner parents turn to an endocrinologist and receive treatment, the greater the chance that a small patient will grow to average height or even higher. Moreover, if the first child was diagnosed with growth hormone deficiency, and the parents are planning a second one, in most cases the second child does not repeat this hormonal problem.

YOU SHOULD KNOW IT

Bone (or biological) age shows whether the growth and overall development of bones corresponds to how old and months old the child is. This is a more accurate indicator than height or body weight. In children's bones there are so-called growth zones, due to which the skeleton can increase. These growth plates gradually close towards the end of puberty, the skeleton ossifies and growth ceases. Bone age allows doctors to understand how long the child will continue to grow, whether it is necessary to look for hormonal pathology, or whether there is no reason for this. True, even in healthy children, the deviation of bone age from the real one can be up to 3 years.

So that the child grows well

Dairy products, since calcium - construction material for a growing organism.

Vegetables and fruits. Carrots containing beta-carotene are especially useful. In order for this microelement to be better absorbed, raw carrots must be grated and seasoned with sour cream or butter.

Protein products - meat, fish, caviar (in the absence of food allergies).

Those children who spend a lot of time outdoors, play outdoor games, and play sports grow better. By the way, if you want your child to be taller when you choose sports section, give preference not to strength sports, but to basketball, volleyball, and tennis.

Sleep plays a special role: 70% of growth hormone - somatotropin - is produced at night. If you put your baby to bed late, he sleeps restlessly, often wakes up, and the production of growth hormone is disrupted.

Vegetarianism and observing religious fasts are unacceptable for children, as are fast food and semi-finished products (sausages and sausages - they have almost no complete protein).

Vitamins and minerals. First of all, vitamin D, a deficiency of which develops rickets. Currently, doctors’ recommendations are to give it to all children in a prophylactic dose, approximately 10 mcg per day.

Calcium and iodine. At 6–10 years of age, children should receive 800–1200 mg of calcium and 150 mcg of iodine per day. And teenagers – 1200–1500 mg of calcium and 200 mcg of iodine. The best source of calcium is cottage cheese, but you can’t eat so much of it, so about half of the calcium needs to be taken in tablets. Another option is calcium-fortified foods. As for iodine, only those who live near the sea receive it in abundance: drinking water and seafood there are rich in iodine. Iodized salt is not enough, so iodine supplements are another essential for growth.

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If the child is a giant

“Grows well, big guy,” that means good health“says the proud father, patting his son on the shoulder, who in three months has grown a head taller than him. This is partly true: if the body develops quickly, it means it is healthy. However, it is precisely this very rapid growth rate that makes adolescence a time of increased health risk.

Gigantism (or macrosomia, tall stature) develops in children with incomplete skeletal ossification processes. It is more common in teenage boys, and is detected already at the age of 9-13 years, progressing throughout the entire period of physiological growth. With gigantism, the child's growth rate and indicators by the end of puberty reach more than 1.9 m in women and 2 m in men, while maintaining a relatively proportional physique.

The height of adults from 175 cm to 200 cm is considered sub-giant. People over 200 cm are considered giants.

“Not everything is good, just a lot of it”

The child is growing quickly. Too fast - compared to peers. As a result:

The vessels do not keep pace with the development of tissues, which is why their nutrition deteriorates;

Different parts of the same organs develop unevenly, creating structural defects and interruptions in normal functioning;

Bones that are soft during this period are susceptible to bending due to alternating weakness and tension. different groups muscles pressing on them.

All this leads to the occurrence of adolescent diseases. Their specificity is that a “banal” problem, overlooked during the rapid growth of adulthood, can seriously “undermine” a young organism in just six months.

If the child grows and gets better proportionally, there should be no problems. It’s worse if a child, while rapidly gaining centimeters, also rapidly loses kilograms. These children - thin and tall - are at risk. They most often develop so-called growing pains. In second place in the risk group are fast-growing and leading sedentary lifestyle In life, children spend a lot of time at the computer or TV: their muscles are very weak, and it is difficult for them to “hold” extra centimeters on themselves.

Cause of tall stature

1. Constitutional-hereditary;
2. Endocrine

3. Chromosomal genetic;
4. Premature sexual development in young children.

What are the dangers of speed?

- Mitral valve prolapse.Occurs in approximately every 10th schoolchild aged 12 to 15 years. Caused by the fact that the mitral valve grows faster than the heart tissue (myocardium). The result is a condition similar to a heart defect.

- Rachiocampsis.Growing bones, including the spine, easily take the shape that muscles and loads on the upper shoulder girdle force them to take. If they are significant, then the child has a chance to develop scoliosis - a lateral curvature of the spine. In most cases, six months of physical therapy and massage will be enough to correct your posture. In advanced cases, you will need a special corset.

- Deterioration of vision.The vicious chain of “height – poor posture” has one more link – deterioration of vision. This is a direct consequence of an incorrect position at the table while reading, as well as a lack of lighting in the workplace. The disease can progress until the end of puberty, gaining diopter by diopter. Glasses and vitamins stop the deterioration of vision, but do not return it, because the key point in vision is the weakening of the eye muscles, which they do not affect. The eye muscles are strengthened by hardware vision correction on a video simulator, computer or lens, as well as special massage and treatment.

- Stretch marks.Many children whose growth is accompanied by weight gain develop large red and then whitish stretch marks on their bodies. This happens due to the fact that the skin of adolescents is thinner, easily stretched and injured, and the subcutaneous fat layer grows faster than the skin. As a result, the skin stretches and is replaced in places of growth with connective tissue. However, sometimes the cause of stretch marks is hormonal imbalances, which may or may not have anything to do with growth.

REFERENCE

“Giant” children complain of fatigue and weakness, dizziness, headaches, blurred vision, pain in joints and bones. Decreased memory and performance capacity lead to deterioration in school performance. Gigantism is characterized by hormonal disorders, mental and sexual function disorders.

Is it possible to identify and treat growth disorders?

It is good when signs of dwarfism or gigantism are noticed in childhood. If a child is 2 years behind or ahead of his peers in growth, you need to consult a doctor.

Of course, the constitution and height of the parents are taken into account here. Doctors must conduct a comprehensive examination of the child. The level of somatotropic hormone in the blood is determined, and an X-ray examination of the skull is performed. Treatment is carried out by an endocrinologist. In case of growth hormone deficiency, replacement therapy is prescribed. This means that until a certain age the child will take pills that contain growth hormone. Often with dwarfism, there is a lack of thyroid hormones and sex hormones. They can also be replaced with drugs. This treatment gives good effect, if started before 5–7 years. In parallel with hormones, medications are prescribed that improve metabolism and promote muscle growth. Parents should also take care of good nutrition for their child, since bone growth requires a lot of “building material.”

Treatment of gigantism depends on the cause of its occurrence. Therapy should begin in childhood - only then will children with short stature “catch up” with their peers, and very tall children will stop growing at an “accelerated” pace.

We thank the endocrinologist of the YMC for his help in preparing the material Anna Petrova and pediatrician Svetlana Sofronova.