What is Normal Growth?

Normal growth is the increasing of both height and weight through cell division and growth. It depends on genetic background, hormone levels, and nutritional conditions etc.


Growth is divided into 4 steps

During infancy, children grow rapidly; then the rate of growth slows as they get older. But when puberty begins, the growth velocity accelerates again. After puberty ends, no further growth can be seen.
Before puberty, normal children grow over 5 cm a year. Children who grow less than 4cm a year should see a doctor for a proper diagnosis and treatment of short stature.


What is Short Stature?

Children with Short Stature are medically defined as those who belong to the bottom 3 percentile (%) of the same age and gender group.


Self-diagnosis for Short Stature

If you answer 'yes' to one of the 3 questions below, you have the possibility of having short stature or growth disorders. Therefore, you should get proper medical examinations from a pediatric endocrinologist first.

1. Are you growing < 6 cm/year before 4 years?
Are you growing < 5 cm/year during 4-8 years?
Are you growing < 4 cm/year before puberty?

2. Are you more than 10cm shorter than your same age and gender group?

3. Are you one of the 3 shortest in your class?

Hereditary Short Stature / Familial Short Stature

When one of the family members has short stature, their offspring might end up in the lowest 3rd percentile of their age and gender group as adults, despite growing at normal rates.
Among the children with shortest height within the 3rd percentile, heredity is one of the most common causes for short stature.
Treatment with growth hormone can increase growth development in this cause as well as other causes of short stature.


Constitutional Growth Delay with Delayed Adolescence

Children might also have constitutional growth delay, which means they have normal growth rates as young children, but they reach puberty and experience a ¨growth spurt〃 later than their peers.
Children who experience constitutional growth delay typically have at least one parent who also experienced constitutional growth delay and delayed puberty.


Nutritional Deficiencies

An unbalanced diet prevents children from attaining their full growth potential.


Medical Conditions Causing Short Stature

There are various medical conditions that can cause growth failure, including but not limited to chromosomal defects. Heart disease, chronic lung, kidney, liver, or gastrointestinal disease can cause a child's growth rate to be slower than what is considered normal for her/his age, gener, and genetic background.

(1) Short Statue due to Lack of Adequate Hormone Secretion
Short stature can be caused by deficiency or insufficiency of growth hormone, thyroid hormone (thyroxine).
Despite their normal body proportion, children with growth hormone deficiency show short stature than do normal children.

(2) Short Stature due to Congenital disorders

- Turner syndrome (TS)

Turner syndrome is a genetic disorder affecting only females. Patients with TS have one X chromosome in some or all cells; or have two X chromosomes but one is damaged.
Signs of TS include short stature, broad chest, webbed neck, cubitus valgus, and loss of ovarian function. During puberty, a girl with TS experiences late breast development and absent menstruation. Her bones and cartilage show abnormal development which results short height and disproportionate body.


- Intrauterine Growth Retardation

A baby with nutritional deficiency or affected by maternal infections during gestation has a tendency of much lower weight at birth, which continues to adulthood and results in short stature.


(3) Short Stature due to Chronic Diseases

There are various medical conditions that can cause growth disorder, such as congenital heart disease, chronic renal failure, chronic pulmonary disease, chronic liver disease & gastrointestinal disturbance.


(4) Short Statue due to Precocious Puberty
Generally, children, who show signs of secondary sexual characters before 8 years in girls and 9 years in boys, are said to have precocious puberty.
Increase of sex hormones is commonly found in children with precocious puberty, which results growth promotion and finally the bone age gets older than the chronological age.

If children are not treated, early epiphyseal fusion occurs and results short stature. Therefore early diagnosis & proper treatment should be performed for these children.

Diagnosis of Short Stature

In order to check if a child has short stature, it is important to know both child's current height and his/her growth velocity history for the last 2-3 years. It is very helpful to know his/her medical history and nutritional conditions from infancy to childhood, mother's gestational period, and family members's height, medical history and genetic background.


Checkups for Short Stature

The most important indicator of children's growth is the growth velocity, not their current height. The growth velocity can be easily measured from each year's physical examination data in school.
When an abnormal growth velocity is observed during recent 2-3 years, the child should get a medical evaluation by a pediatric endocrinologist. The medical evaluations recommended are numbered below, depending on the child's physical conditions.
With the test results, a doctor can find out the cause of short stature, current bone age, predicted adult height and need for treatment.

(1) Medical History of child & family
* Child: eating patterns, physical conditions at birth, and medical history from infancy to childhood.
* Family: sexual maturation, growth patterns, any medical history, eating habit and status during birth

(2) Physical Appearance
Child’s height, weight, body proportion, head circumference, and length of arms and legs etc.

(3) Bone Age
Radiography of hand and left wrist joints to measure bone maturation, which is closely related with child’s growth

(4) Blood Test (Hormone)
* Detection of growth hormone, thyroid hormone (thyroxine), sex hormones and adrenocortical hormone in blood

* Growth hormone stimulation test, when it is suspected that child's short stature is caused by growth hormone deficiency

(5) Chromosome Test
Karyotyping test for girls with short stature, who possibly have Turner syndrome

What is the treatment of short stature?

A growth hormone can usually help children with short stature to grow normally.



Growth hormone is secreted from the anterior pituitary. It promotes lipolysis and protein synthesis as well as induces growth of bone and cartilage.


When is the proper time for treatment of short stature?

It has been reported that growth hormone treatment is the most effective before the onset of puberty.
Treatment of short stature should begin when children are in the lower grades of elementary school, well before the puberty begins (boys, 15 years old; girls, 14 years old).


How long should I administer growth hormone?

Growth hormone is found to be effective when it is administered over 2-3 years or at least 6 months.
It is widely recommended that growth hormone be administered continuously before bone maturation until the onset of puberty. Especially, a long-term treatment is important for children with familial short stature.


How do I inject growth hormone?

Growth hormone is mostly secreted during deep sleep in normal people. To follow hormone secretion balance, growth hormone injection is given every night before sleeping.
Growth hormone is injected under the skin or into the muscle, which is a relatively simple procedure. Most people can do it easily after simple training.


Where should I go for consultation of growth hormone?

You need to get a medical examination from a pediatric endocrinologist. Growth hormone treatment falls under the preview of a specialized part of pediatrics, i.e. pediatric endocrinologists who can give you detailed information and also provide counselling.


How much growth can be expected with growth hormone treatment?

According to the clinical study results conducted in Korean medical schools of Seoul National University, Yonsei University and Catholic University, children with a growth disorder generally grow less than 3 cm a year before treatment. Average growth of children after 1 year of treatment usually ranges from 8-12 cm up to the maximum of 15.5 cm. Average growth of children after 2 years of treatment is 18 cm up to the maximum of 23.5 cm. Thus children get to grow more than 12 cm than predicted at pre-treatment.
Children with familial short stature, which is the most common cause of short stature, will grow average 8cm a year during the 1st year of growth hormone treatment.

Lifestyle adjustment


(1) Exercise for Growth

Since higher pulses of growth hormone secretion occur during a deep sleep and right after exercise, exercise is important during the growth period. It helps to increase the secretion of growth hormones and growth hormone stimulates the growth plate, which results acceleration of growth.

It also assists muscle to develop and calcium ions to be absorbed into the bones, increasing bone mineral density for strong and healthy bones, which in turn can promote growth.

However, not all exercises help growth. Extremely hard exercises, which cannot continue for long time, are unsafe for promoting good growth. Then, which exercises help growth?

- Good for growth
Stretching, swimming, dancing, free gymnastics, volleyball, tennis,
basketball, sprinting, table tennis and badminton

- Bad for growth
Gymnastics with apparatus, wrestling, judo, marathon, rugby and
weightlifting

* Brief introduction of stretching
It is good to do stretching twice a day (every morning and night).
At the first time, we recommend doing the easiest thing for 10 ~ 30 seconds. You can stretch until you feel relieved.

Stretching arms upward: Lock knuckles above the head with palms upward and lean arms backward

Stretching arms backward: Stretch arms backward and turn arms slowly inward.

Inclining neck with catching your wrist: Pull the right arm across the body with spreading both arms backward and lean the side of head on the left shoulder.

Inclining neck with pressing your elbow: Gently stretch elbow backward the head with arms over the head.

Drawing knee while lying down: Bend knee and draw it gently to the chest until you fully feel stretched.

Catching ankle with bending the body: Bend the upper body from the hip for mild stretching the back part of right thigh and the left lower part of back.

Assuming a posture of running start: From a posture of running start, spread legs with one leg closer to the body and the other far to the body and hold down the body.


(2) Food for Growth

During the growth period, children need nutrition for both physical activities and growth promotion. They need to uptake more calories, protein, calcium, and iron than adults do.

But a balanced diet is important, which means getting plenty of nutrients from various source of food, not from one source. Nutritional problems such as strict diet and unbalanced diet prevent body from keeping in good health and promoting growth.

Nutrition is classified into five basic food groups: protein, carbohydrates, fats, vitamins and minerals. During growth period, children should take a balanced diet which includes all of the five food groups at every meal.

- Protein
Protein is a building block of muscle and also a major component of hormones, such as growth hormone.
* Lean meat from beef, pork and poultry
* Fish like mackerel, croakers, hairtail and sardine
* Shellfish like clam, mussel and abalone
* Beans & soy products like bean curd (tofu)

- Minerals
Calcium is a mineral that the body needs for numerous functions, including building and maintaining bones and teeth as well as controlling physical functions. It also directly affects growth development.
* Milk & dairy products like cheese and yogurt
* Dried fish with whole bones like anchovy and whitebait
* Seaweeds like brown seaweed
* Soupbone

- Vitamins
Vitamins assist protein synthesis and help in the absorption of vitamin D & phosphorus thereby maintaining proper levels in the body, which is important for growing bones.
* Vegetables like spinach, carrot and squash
* Seaweeds like green laver, brown seaweed and tangleweed
* Mushrooms like shiitake, champignon and agaric
* Fruits like persimmon, tangerine and strawberry

- Fiber
Fiber promotes movement of the large intestine to clear up harmful wastes from the body and helps beneficial enterobacteria to proliferate in the colon to decrease waste formation.
* Cereals
* Seaweeds
* Fruits & Vegetables