Dwarfism - Treating restricted growth

Human growth hormone can help stimulate growth in children with growth hormone deficiency.

This and other available treatments for short stature are outlined below.

Growth hormone treatment

The National Institute for Health and Care Excellence (NICE) recommends human growth hormone treatment (somatropin) as an option for children whose growth failure is associated with any of the following conditions:

• growth hormone deficiency
• Turner syndrome
• Prader-Willi syndrome
• chronic kidney disease
• children who are born small and fail to catch up in growth by the age of four or later
• children with a particular faulty gene, known as short stature homeobox-containing gene deficiency (or SHOX gene haploinsufficiency)

Children with true growth hormone deficiency respond very well to growth hormone treatment. Growth response in children with other conditions can vary, and treatment may be started at different ages depending on the growth pattern of the child.

For example, growth hormone is given to girls with Turner syndrome as soon as it becomes obvious that they are not growing normally. This may help to improve their adult height.

Somatropin treatment should always be started and monitored by a child health specialist (paediatric endocrinologist) with expertise in managing growth hormone disorders in children. It is usually given as a single daily dose by injection.

Skin reactions are the most commonly reported side effect of somatropin. In very rare cases, the treatment is associated with persistent severe headaches, vomiting and vision problems.

For more information, read the 2010 NICE guidelines on Human growth hormone (somatropin) for the treatment of growth failure in children.

Controlling long-term conditions

Controlling long-term conditions, such as lung disease, heart disease, bowel disease or arthritis, from an early stage can reduce the effect these conditions have on growth.

Children should have regular check-ups with their health team and should be referred to a child health specialist (paediatrician) as early as possible. Their care is likely to involve a team of healthcare professionals, including one or more of the following:

• physiotherapists
• occupational therapists
• dieticians
• hearing specialists (audiologists)
• speech and language therapists
• specialists in nervous system disorders (neurologists)
• specialists in spine and joint problems (orthopaedic specialists)
• children's nurse specialists
• geneticists

Leg lengthening

If a person has particularly short legs, a leg-lengthening process, known as distraction, is an option. This involves breaking the leg bone and fixing it to a special frame. This is gradually adjusted every day to lengthen the bone.

However, this can be a long procedure and has a risk of complications. Also, it may not always have the desired results. As there is uncertainty about the safety and effectiveness of distraction in lengthening the leg bone, it is important to understand exactly what the procedure involves and to talk to your orthopaedic specialist doctor about the risks.

Some people have pain after the limb-lengthening procedure. Other possible complications include:

• poor bone formation
• infection
• bone lengthening at an inappropriate rate
• a blood clot in a vein 

For more information, read the 2006 NICE guidelines on limb lengthening (PDF, 526Kb).