Intelligent and engaging boy stopped growing

A woman brought her 8-year-old son to Philadelphia to our office because she was very worried about him. The typical child grows two to three inches each year, but starting at age 5, her child's growth had slowed to less than an inch a year.

Six months earlier, he'd had a special imaging study that showed marked delay of bone maturity. Blood tests showed borderline anemia. He was a picky eater.

He often was severely constipated and inappropriately tired. His skin was very dry, and his teeth weren't growing well.

Despite all that, he was a very smart child with a delightful personality.

Psycho-social deprivation is the most common cause of growth failure in children, yet this family appeared to be loving and verbal and comfortable together. Not talking to or touching a child can cause him or her not to grow, as can starving the child. But in those cases, height is less affected than weight, and this boy's main issue was height.

Renal tubular acidosis, in which the kidney loses too much bicarbonate and salt, can also cause growth failure. So can any serious disease such as inflammatory bowel disease, rheumatoid arthritis, or cancer. But again, weight is usually more affected than height.

Numerous metabolic disorders, such as low thyroid or low growth hormone can be the culprits, too.

We sent off some blood and urine tests, and had the answer the next morning.

The child's urine was completely normal, but the blood tests revealed several abnormalities. His blood lipids (fats) were higher than normal. The tests of kidney function were borderline abnormal. But the TSH (thyroid stimulating hormone), which the pituitary gland makes to get the thyroid gland to produce thyroid hormone, was 164 times the upper limit of normal - to no avail. The boy was hypothyroid. We started him on artificial thyroid hormone and sent him back to his hometown pediatric endocrinologist to follow his recovery.

Low thyroid function can occur because the thyroid gland is abnormal from birth. Or the body can have an allergic reaction to its own thyroid tissue.

It occurs twice as often in girls as in boys and usually shows up in adolescence. Low thyroid stops height growth but can make the child overweight because it slows the metabolism. Giving synthetic thyroid hormone usually fixes the problem, but it is not clear whether all the lost height can be made up.

This child had several classic side effects of hypothyroidism, including severe constipation, chronic fatigue, very dry skin, and severely delayed bone age. But he did not have other manifestations, such as slow thinking and premature development of secondary sex characteristics.