What they can tell you about growth

Puberty is a time of rapid growth and development for almost every system in the body, not just the reproductive system. Growth spurts occur throughout childhood, but are usually more pronounced during the onset of puberty.

Bone growth assessments can be useful when it comes to assessing growth rates, especially when it comes to understanding1:

  • How much a child is expected to grow up
  • When a child enters puberty
  • What will be the final height of the child

Pediatricians may look to the parents of a child for some of this information, but more specialized assessments can help, particularly if there is a concern for disorders or conditions that may affect growth, development, or growth. bone health.

Katherine Kutney, MD, a pediatric endocrinologist at Rainbow Babies and Children’s Hospital in Cleveland, Ohio, said bone age assessments are usually done with an x-ray of the left hand. Bone age is measured in years and assigned by a qualified radiologist or endocrinologist by comparing the child’s measurements with existing standards. The most commonly used measurement standards for bone age are the Greulich and Pyle Atlas2 and the Tanner-Whitehouse3 evaluations.4

Bone age assessments can provide pediatricians with a rough estimate of when a child will enter puberty, Kutney said. A child with advanced bone age is likely to reach this stage earlier, while a child with delayed bone age is likely to enter puberty later than normal.

There are extremes to be aware of, Kutney added.

“Any child whose bone age is advanced or delayed by more than 2 years, or whose growth pattern deviates from his genetic potential should be referred to endocrinology for evaluation,” she noted.

Genetic potential is determined by the average height of the parents, which is calculated by averaging the parental sizes adjusted for sex.
Kutney shared the following examples.

  • For men, we take the maternal height and add 5 inches or 13 centimeters, and we average this value with the paternal height to obtain the mid-parental size.
  • For women, we take the paternal height and subtract 5 inches or 13 centimeters, and we average this value with the maternal height to obtain the mid-parental height.

Most children will reach a final height within 4 inches of the parents’ average height estimate, she said.

“This may not be the case if the maternal and paternal sizes are discordant, or if the child takes more after 1 parent,” Kutney added.

The timing of puberty also plays an important role in growth.

For a child with an “average” time of puberty, Kutney said pediatricians should expect the child to follow the height percentile corresponding to their final adult height. For example, if a girl has a normal timed puberty and a final height of 5’5 “, she is expected to grow along the 50th percentile during childhood.

When a child experiences an “earlier than normal” puberty time, they are expected to follow a height percentile above their last adult height percentile. This means that a girl who reaches a final adult height of 5’5 “but experiences puberty earlier than average can grow to the 80th percentile during infancy. However, she will stop growing earlier than her peers. to reach final adult height at the 50th percentile, Kutney noted.

Finally, children with puberty “later than normal” are expected to grow at a height percentile lower than their final adult height, but continue to grow longer than their peers. This means that a girl who falls into this category can grow along the 25th percentile during childhood, but continue to grow longer than other children due to delayed puberty and have a final height at the 50th percentile.

Deviations from these patterns or other signs of delayed bone growth should be looked at by a specialist, Kutney said. A number of conditions could contribute to delayed bone age, including5:

  • Hypothyroidism
  • Growth hormone deficiency
  • Other hormonal disorders
  • Nutritional deficiency
  • Chronic inflammatory bowel disease
  • Celiac disease
  • Cystic fibrosis
  • Other chronic inflammatory conditions
  • Immunodeficiency
  • Heart disease
  • Chronic kidney disease
  • Liver disease
  • Psychosocial stress or abuse
  • Trisomy 21
  • Turner syndrome
  • Russell-Silver Syndrome

“Any child crossing percentiles up or down in childhood – after age 3 and before puberty – should be referred,” Kutney said.

The references

1. Nemours Kids Health. Radiographic examination: study of bone age. Accessed November 22, 2021. https://kidshealth.org/en/parents/xray-bone-age.html

2. Alshamrani K, Messina F, Offiah AC. Is the Greulich and Pyle Atlas applicable to all ethnicities? a systematic review and a meta-analysis. Eur Radiol. 2019; 29 (6): 2910-2923. doi: 10.1007 / s00330-018-5792-5

3. Cox LA. Tanner-Whitehouse Method of Skeletal Maturity Assessment: Common Problems and Mistakes. Horm Res. 1996; 45: 53-55. doi: 10.1159 / 000184848.

4. Satoh M. Bone age: assessment methods and clinical applications. Clin Pediatr Endocrinol. 2015; 24 (4): 143-152. doi: 10.1297 / cpe.24.143.

5. Cavallo F, Mohn A, Chiarelli F, Giannini C. Assessment of bone age in children: a mini review. Pediatrician before. March 12, 2021. 9:21 a.m. doi: 10.3389 / fped.2021.580314.

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