Normal growth and development during infancy into childhood and adolescence requires the action of many hormones, influenced by an individual child’s genetic make-up and their environment (healthy nutrition and physical activity/exercise and a nurturing family and stimulating learning environment).
Along the way a child’s growth may be impaired by either a deficiency or excess of different hormones e.g. growth, thyroid, cortisol, and pubertal hormones.
Under (hypothyroidism) or overactive (hyperthyroid) thyroid diseases are common endocrine disorders that affect growth and neurodevelopment.
The commonest hypothyroid disorders are congenital hypothyroidism and Hashimotos’ thyroiditis, and the commonest hyperthyroid condition is Grave’s Disease, which can sometimes also affect the eyes and heart function.
All children grow at different rates dependent on their genetic potential, but disorders of the key endocrine glands can impact adversely on that genetic potential. This includes disorders of the pituitary, thyroid and adrenal glands that affect height, weight and pubertal development. More often than not the child’s current height is related to their parental height, birth weight and length, underlying genetic syndromes or major organ abnormalities (kidney, lung , heart and bowel) and nutritional deficiencies, rather than hormonal problems.
Puberty consist of two components: adrenarche (activation of the adrenal glands production of hormones which may lead to pubic hair development around about 8-10 years of age) and gonadarche (ovarian production of the female sex hormone oestrogen in girls and testicular production of testosterone in boys). Usually gonardache begins in girls from the age of 10 years and in boys from 12 years of age with the whole pubertal growth and sex development process taking 3-4 years with onset of menarche between 12-13 years and Masculinisation (voice breaking, growth spurt and increase in body hair and muscle in boys after 14 years of age).
More children are presenting with signs of earlier puberty and the reasons for this are not clear, but may be related to the child obesity epidemic and/or exposure of mothers during pregnancy and children to endocrine-disrupting chemicals which are ubiquitous in our environment and food chain (see link to Scientific statement from Endocrine Society of USA).
Precocious puberty occurs in girls before 8 years of age and in boys under 10 years of age and may lead to significant reduction in final adult height, physical changes of puberty in primary school which may be both physically and psychologically concerning to the child and the parents.
Delayed puberty is lack of sexual development in boys 14 years of age and girls under 12 years of age. This could simply be related to familial factors with history of one or both parents with delayed puberty, or less commonly a result of either a pituitary problem (see hypopituitarism) or problem in the ovary in girls and testes in boys. Whatever the result often adolescents will have associated major psychological and body image problems arising from their lack of sexual development and short stature compared to their peers.
Sometimes children are born without a clear gender identity at birth because of ambiguity of their external genitalia. This is obviously a very concerning and worrying health event for the parents of the newborn child.
With the recent advancement in genetic, hormonal and biological understanding of the many and varied disorders affecting sexual development, it is nevertheless possible to make a relatively quick diagnosis and achieve excellent outcomes for a child with a disorder of sex development (DSD).
This may require the professional help of an experienced paediatric endocrinologist with your general paediatrician, urological paediatric surgeon, geneticist and genetic counseller and a family clinical psychologist.
Obesity within our society is the major child health problem of our age. 1 in 4 children are now overweight or obese while 2 in 3 adults are similarly affected leading to rising rates of Type 2 Diabetes Mellitus, cardiovascular disease, non-alcoholic fatty liver disease, osteoarthritis, some cancers and mental illness (depression, anxiety and low self-esteem and poor body image).
While we all have a responsibility for ourselves and our Families to stay healthy and active, the truth is that in our society, as it is currently structured that without concerted efforts on the part of parents as their children’s role models, ALL OF US (parents, children and their doctors alike) gain weight excessively and place ourselves at risk of the many health complications of obesity.
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Osteoporosis or fragile bones which can predispose to fractures (broken bones) is usually a condition of the elderly population, but can occur in children and adolescents with genetic disorders (osteogenesis imperfecta, genetic rickets)or in children and adolescents who have chronic disease (steroid-induced, kidney, neuromuscular disorders, heart and lung and inflammatory bowel disorders).
Monitoring of bone mass in children is complicated requiring an understanding of the growth process, but can be done by DXA and pQCT scanning. It is essential that for optimal bone health children and adolescents receive the recommended intake of calcium and vitamin D and adequate physical activity/exercise.