Hormonal issues in children

Dr Saima Hanif, a pediatric endocrinologist at Mississippi Centre for Advanced Medicine, USA talks about hormonal issues in children

SN: Which health issues are treated by an endocrinologist?sni

An endocrinologist is trained to treat diseases of different glands. Glands make hormones so in other words they treat disorders related to hormone imbalances. In kids, endocrinologists treat growth and puberty disorders, diabetes, low blood sugar and thyroid problems. They also look into disorders of the pituitary and adrenal glands. Calcium and bone disorders and some disorders of water/salt balance and polycystic ovarian syndrome.sni

SN: What is hormonal imbalance?sni

There are many different hormones in our body and disturbance of each one leads to a different disease. For instance, growth hormone is involved in increasing height in children. Its deficiency can cause short stature while excess can cause tall stature, increased size of hands and feet and other issues. Pancreas makes insulin that helps maintain blood sugar. Insulin deficiency causes diabetes whereas excess of insulin causes problems associated to low blood sugar.sni

SN: Are hormonal problems increasing in children nowadays?sni

Some endocrine diseases like diabetes are increasing in children. Type 1 diabetes is an autoimmune disease. Genetic and environmental factors may both be at play for its increasing incidence, but reasons are not completely understood. Type 2 diabetes which is related to overweight and obesity is occurring more in children due to inactive lifestyles and changes in diet.sni

SN: Which other hormones are responsible for growth and development?sni

Other than growth hormone, thyroid hormone made by thyroid gland in the neck is important for growth in height and brain development, especially in the first few years of life. Puberty hormones are essential for the growth spurt of puberty.sni

SN: Do kids experience any social issues due to early or late puberty?sni

Early or late puberty can cause issues related to psychological adjustment to body changes or lack of changes as compared to their peers. Kids especially boys may be teased or bullied at school when they are late in puberty and girls may feel lonely and confused if they start periods too early.sni

SN: Which factors affect growth?sni

There are many factors and diseases that can affect growth. Poor nutrition is one such factor – being underweight can affect growth. Diseases of intestines that affect nutrient absorption are another reason. Any chronic illness related to liver, kidney or inflammatory disease can affect growth. Moreover, poorly controlled type 1 diabetes and deficiency of thyroid hormone, growth hormone and puberty hormone can also cause the problem. Severe vitamin D deficiency in young kids and certain bone and calcium related disorders can also lead to short stature and poor growth.sni

SN: Some say that height stops growing after 18 years of age. Is it true?sni

Most children stop growing before 18 years of age. When someone will stop growing is linked to their puberty timing. Puberty hormones initially cause a growth spurt but eventually result in closing the growth plates (open areas in our bones where more bone can grow). Once the growth plate closes, a person stops growing in height.sni

Girls experience puberty and growth spurts earlier but also stop growing at a younger age. Once they have had the first period, there is usually not much growth in height. Boys have puberty and growth spurts later than girls but usually stop growing by 16 years of age. Some boys can however, continue to grow much later if they experienced delayed puberty.sni

SN: Mothers, usually concerned about their child’s height, tend to compare them with their peers. Should they really worry?sni

Growth concerns need to be evaluated by a doctor as there are many factors that need to be accounted for. For example, a child before puberty grows at a slower rate whereas during puberty, growth rate increases. Every child has a different time of puberty so a 12 years old girl who has not started puberty yet will seem shorter compared to peers. But she may be completely healthy. Once she starts puberty and her growth spurt, she might even grow taller than her peers. But understandably, parents may get worried.sni

Parental height affects a child’s final height potential as well. It is important to monitor growth through charting on a growth chart during regular yearly doctor visits. If growth rate is slowed, then further evaluation of the hormones as well as other causes of poor growth is recommended.sni

SN: Why do some children grow to a normal height although their parents are short?sni

Well, one possible reason can be that the parents have had health issues or did not have the best nutrition when they were kids that affected their growth. For example, they used to get infections frequently and did not eat well or were picky eaters or had other diseases that affected nutrient absorption. These parents were likely to have genetic information to be tall but they just did not have enough building blocks to grow when they were kids. Now, their kids have better nutrition, so they are able to meet their full genetic potential.sni

SN: What are some natural ways to increase height and till which age are they effective?sni

Good nutrition and good night sleep are important to optimize and reach growth potential. Good nutrition includes enough caloric intake for age and activity level and well balanced diet that includes protein, calcium, vitamins and minerals. As I said before, it depends on puberty timing and timing of growth plate closure.sni

SN: Can involving kids in hanging activities help gain height?sni

There is no evidence to back this myth. Through stretching, one can have a mild temporary increase as spine decompresses but that is not substantial.sni

SN: What are the effective treatment options for increasing height?sni

It depends on the cause. In case of thyroid problem, thyroid hormone replacement is needed. Growth hormone therapy is needed in case of growth hormone deficiency. For diabetics, glucose management may need to be improved. If growth failure is due to some other reason, underlying health issue needs to be treated. Height can only increase if growth plates are open so if someone has already gone through puberty and growth plates are closed, treatments will not increase height further.sni

SN: What is the difference between type 1 and type 2 diabetes?sni

In type 1 diabetes, body’s immune system attacks and destroys pancreas cells that make insulin. Insulin helps push sugar from the blood into the cells of our body so they can use it for energy. When there is no insulin, the sugar just stays in the blood causing diabetes or high blood sugar.sni

In type 2 diabetes, pancreas is able to make insulin but insulin is not able to do its job. The reason for this is obesity or overweight. Obesity causes insulin resistance in our body which makes it hard for insulin to do its job. Eventually, in type 2 diabetes, the pancreas can get really tired of making insulin to keep the sugar level in check and eventually may just stop making enough insulin.sni

SN: What are the early indicators of Type 1 diabetes?sni

Increased urination, thirst, weight loss and decreased energy are the common signs of diabetes. Many times they go unnoticed or are attributed to other reasons. If you notice your child going to bathroom frequently and waking up at night to go pee or drink water more than usual (make sure they drink water and not juice if you notice they are drinking too much) and losing weight despite eating plenty, take him to a doctor immediately.sni

Insulin treatment if not started timely especially in Type 1, can lead to Diabetic ketoacidosis (DKA). It is a serious condition that causes vomiting, dehydration, rapid breathing, confusion and very sick appearance. It can also be life threatening.sni

SN: What are the advancements in treatment of diabetes? Are they available in Pakistan?sni

Diabetes management has greatly advanced and improved in the last few years. Previously, type 1 was managed with multiple insulin injections through needles or pens (5-6 or even more per day). Now insulin pumps are available that are attached to arms, belly or legs and same pump site can be used up to three days. One only needs to enter information like number of carbohydrates eaten and current blood sugar level and the pump delivers insulin without the child feeling anything.sni

Also earlier, blood sugar was checked by pricking fingers. But now continuous glucose monitors (CGMs) are available that can be placed on arms and other areas on the body to give quite accurate values. These can stay on usually for up to two weeks and glucose information can be viewed on a phone or another device. Most recently, the CGM and insulin pump can talk to each other as well, which helps manage sugar levels even better.sni

Technology has improved the life of kids with less poking and pricking and better glucose management in most cases when is used appropriately. Not all types of pumps or CGMs are available in Pakistan. Local doctors will be better able to provide this information.sni

SN: Which type of thyroid issues are common in children?sni

In newborns, most common thyroid issues include being born without thyroid gland. Other than this, the gland can be small in size, located in wrong place or have a defect so it cannot make enough hormone. A baby can be affected if the mother also suffers from the disease. In older children, thyroid can be attacked by immune system and cause underactive or overactive gland. Iodine deficiency or excess can also cause this.sni

Deficiency of the hormone causes poor growth, weakness, poor school performance, dry skin, constipation, hair loss and brittle hair, menstrual irregularities and heavy periods. An excess on the other hand can cause palpitations, restlessness, inability to fall asleep, irritability, weight loss and menstrual problems. These issues can be treated by medicines, radioactive iodine or surgical intervention.sni

SN: What are the symptoms of congenital hypothyroidism?sni

Congenital hypothyroidism most commonly has no signs and symptoms initially. But if not diagnosed and treated early, symptoms will start to show up. Symptoms include prolonged jaundice, yellow skin, increased sleepiness, poor feeding and weakness and umbilical hernia. If not treated timely, brain and intellectual development is affected. Hence it is important to check for it with a blood test soon after birth.sni

SN: Any take home message for parents?sni

Try to practice and model healthy lifestyle behaviors for children and encourage them to make healthy diet choices. Make an effort to provide opportunities for physical activities and sports and limit screen time. Any concerns for growth or puberty should be discussed with a pediatric specialist for timely treatment.sni