In Switzerland, about 2500 children are born each year with a weight or height that is too small in relation to the gestational age (Small for Gestational Age). Prof. Dr. med. Urs Eiholzer from the Pediatric Endocrinology Center in Zurich explains in an interview why it is so important to check growth regularly, especially in SGA children.
Can a cause always be found when a child is very small at birth?
Prof. Urs Eiholzer, MD:
In most SGA children, growth does not slow down until the last third of pregnancy. These children are usually underweight with normal length. However, some SGA children always grow a little too little throughout pregnancy, mainly affecting body length. Reasons may include poor placental function, EPH gestosis, high blood pressure, or chronic maternal disease. In more than half of the cases, however, the reasons are unclear.
So what are the prognoses for SGA kids?
Today we know that most SGA children catch up in terms of height during the first two years of life. Especially in children who have grown insufficiently due to placental insufficiency in the last months of pregnancy, the chance for catch-up growth is great. However, approximately 9-13% of SGA children are unable to make up the shortfall and require careful monitoring. These are often those children who have suffered from malnutrition throughout pregnancy. These children are at great risk of being small as adults as well – and even smaller than growth projections suggest.
Why are so few SGA children diagnosed and treated in Switzerland?
There are several reasons for this. It is often the case that these children grow parallel to the 3rd percentile and parents and doctors simply hope that they will catch up later. Unfortunately, reality shows the opposite: SGA children who have not caught up during the first two years of life and who have not been adequately treated fall even further behind in puberty compared to their peers. Treatment with growth hormone can help not only children with a growth hormone deficiency, but also SGA children to (almost) reach their target height, even if they do not have a growth hormone deficiency. Children with SGA require higher levels of growth hormone to grow according to genetic guidelines.
Why is early diagnosis and treatment recommended?
It is critical that treatment be started as early as possible for any disorder for which growth hormone is indicated as a therapy. Then the chances are that the child will reach a normal or near normal size in adulthood.
What does the success of therapy look like for SGA children?
The goal of treatment is for the child to reach the genetically predetermined final size if possible. This goal is most likely to be achieved if treatment is started early. In SGA children, growth is enhanced by growth hormone by about 6-12 cm. However, despite treatment, these children often remain smaller than their target family size would suggest.
Interview: Susanna Steimer Miller
HAUSARZT PRAXIS 2015; 10(3): 44-45
