生長曲線

孩子隨著年齡增長有不同的生長速度，以下是一般嬰兒至青春期的平均生長速率：

嬰兒至青春期兒童的平均生長速率表:

嬰兒時期的身體發展迅速，由一歲至九歲可見生長速度正在逐漸減慢，如果孩子於四歲至九歲時高度增長少於四厘米，便屬於生長遲緩。如生長速率不及預期，家長應帶孩子接受檢查，因為孩子生長發育緩慢可能由內分泌疾病而引起，不可忽視。如能讓兒科醫生及早發現孩子生長發育上的問題，可以透過適當的療法：如生長荷爾蒙注射 (生長激素)令孩子重回正常生長線。

參考資料: i-growth.com.hk/growth-chart.html

以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，

應向自己的兒科醫生查詢，而不應單倚賴以上提供的資料。

生長荷爾蒙

子女生長

父母憂心子女的高度，因高度會影響孩子的未來際遇和前途，其實高度增長與否，可能跟身體健康有莫大關係。不少家長誤以為高矮只是靠遺傳的，其實非也。遺傳是其中一項重要的因素，還有不少其它因素都能影響孩子的高度，而且通過生理科學的辦法可以幫助孩子達到正常的高度。

生長曲線

孩子隨著年齡增長有不同的生長速度，以下是一般嬰兒至青春期的平均生長速率：

嬰兒時期的身體發展迅速，由一歲至九歲可見生長速度正在逐漸減慢，如果孩子於四歲至九歲時高度增長少於四厘米，便屬於生長遲緩。如生長速率不及預期，家長應帶孩子接受檢查，因為孩子生長發育緩慢可能由內分泌疾病而引起，不可忽視。如能讓兒科醫生及早發現孩子生長發育上的問題，可以透過適當的療法：如生長荷爾蒙注射 (生長激素)令孩子重回正常生長線。

生長荷爾蒙 / 生長激素

根據醫學研究指出，生長荷爾蒙會刺激骨骼增長。因為生長荷爾蒙需要於孩子進入青春期前使用，所以愈早開始使用生長荷爾蒙注射，可以有較充裕的時間發揮生長荷爾蒙的增高效果，幫助孩子追回正常成長軌道。

生長荷爾蒙 / 生長激素 的應用

於接受療法前，兒科醫生會為孩子進行初步的身體檢查和X光檢查以了解骨齡和相應的年齡是否一致。然後再配合接受血液測試，以測試血液中的IGF-1 和 IGFBP-3的水平是否正常。此外，孩子還有可能需接受性荷爾蒙、肝臟和腎臟功能、甲狀腺毒分泌是否正常的檢查，以確認他沒有任何疾病或不正常並找出矮小症的原因。根據醫學研究指出，生長荷爾蒙療法能有效解決生長荷爾蒙缺乏、出生小於胎齡，自發性身材矮小和特納綜合症而引起的矮小症問題。

生長荷爾蒙 /生長激素 的副作用

生長荷爾蒙至今已經使用了超過三十年，當中有少數人會出現水腫、生長痛、血糖增高和腦壓高的副作用。患有心臟病和糖尿病的孩子均不適合注射生長荷爾蒙，因為生長荷爾蒙可能會令血糖增高。有些家長會擔心長期注射生長荷爾蒙會引致癌症等副作用，其實多份醫學報告已經證實生長荷爾蒙相比安慰劑的研究組並不會增加癌症的風險。建議家長與醫生討論後才決定是否接受治療。

參考資料: i-growth.com.hk/growth-hormone.html

以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，

應向自己的兒科醫生查詢，而不應單倚賴以上提供的資料。

Growth hormone therapy benefits

Monitoring response to growth hormone therapy

Response to growth hormone therapy should be monitored every 3 months, so that the dosage can be optimized accordingly. This should be done for a year to take into account the time it takes to see a response to dose adjustment as well as seasonal variations in growth velocity. Children usually grow faster in summer, probably because they have more exercise and sleep.

Growth rate during the first year of growth hormone therapy is the best predictor of response. If first-year growth velocity is suboptimal despite use of an optimal dose, I would consider treatment discontinuation. These patients may have underlying problems that clinicians should investigate further.”


Compliance to growth hormone therapy

is very important to assure optimal results. Parents need to ensure that the correct dose is being administered and that spillage does not occur. The mode of injection and dosing plays an important role on the outcomes.

Auto-injection devices are easy and comfortable to use and may improve adherence to therapy. Good adherence leads to optimal efficacy and allows children to reach their height potential. [BMC Endocrine Disorders 2011;11:4]



Growth hormone therapy side effects

The safety data available on idiopathic short stature (ISS) patients treated with growth hormone are good, with mild transient increases in fasting glucose that remained within the normal range. Growth Hormone did not increase bone age acceleration or the tempo of pubertal development. [Clin Endocrinol Metab 2005;90:5188-5196]
Conclusion

Most of the time, Growth hormone therapy is tailor-made to address the individual need of the child.

Although there are no universally accepted biochemical criteria for determining when to initiate growth hormone therapy for children with ISS, the initial response to therapy and dose of growth hormone may contribute to the success of therapy and play a significant role to maximize adult height. [Horm Res 2009;71:70-74]




References:i-growth.com.hk/growth-hormone-therapies.html

It is not intended as medical advice to any specific person. If you have any need for personal advice or have any questions regarding your health, please consult your pediatric doctors for diagnosis and treatment.

Growth hormone therapy for kids - An early start to growth hormone therapy

For children with idiopathic short stature (ISS), growth hormone therapy is usually started at the age of 3-4 years, although early initiation of therapy is recommended, parents usually don’t notice that their children are short until they are at school age, when there is comparison with other children.

In any case, growth hormone therapy should be started in pre-pubertal age (girls not more than 6 years of age, boys not more than 7 years) to optimize growth outcomes. [Int J Pediatr Endocrinol 2013;2013:22]

In addition to younger age at start of growth hormone therapy, other variables associated with better response in patients with ISS include first-year growth response, the difference in height at the start of treatment from target height SDS, and growth hormone dose.

Further, height at onset of puberty highly influences final height. Pre-pubertal children with ISS who show an appropriate first-year response to GH are likely to benefit from long-term treatment, even on a low dose of growth hormone. [Horm Res 2007;68:53-62]
First year growth velocity: An important predictor

The first year of growth hormone treatment is very important because growth during this period is often fastest and can affect how much the patient is likely to grow later. If the child does not respond to growth hormone therapy in the first year of treatment, it is expected that the treatment will not be successful later on.

Further, if a very high dose is required to achieve a positive response in the first year of treatment, it can be inferred that the patient is GH-resistant to a certain degree.

Kriström and colleagues recently developed a model using growth response data from 162 pre-pubertal children born at term. The model was constructed to predict long-term growth response to growth hormone therapy based on observed first-year growth response.

It serves as a tool for identifying those children who may benefit from long-term growth hormone treatment. This model is valid worldwide for the prediction of up to 7 years of pre-pubertal growth in children with ISS. Figure 1 shows the observed growth response, for comparison with the predicted growth response made after 1 year on treatment, on the four variables: age, gender, height at start of treatment and height after 1 year on GH treatment. [BMC Med Inform Decis Mak 2009;9:1]

Left panel: The response score (RS) gives a measure of growth in response to GH. For each individual child at treatment time 1 year (x-axis), the observed growth response (Δheight SDS) is found on the y-axis to the left and following the corresponding curve the individual RS can be found to the right.

Middle panel: Observed first-year Δheight SDS on treatment for three prepubertal children from the validation group (filled circles). The individual calculated RS (dotted line) is found on the right axis.

Right panel: Individual RS from the same three children, based on observed Δheight SDS on treatment at different time points (filled circles at treatment time 2, 3, 4, 5 and 6 years) in comparison with the predicted (dotted line). RS was consistent over time within an individual child, and the inclusion in the model of measurements made later than 1 year after the start of growth hormone treatment are acceptable.

Growth velocity in pre-pubertal children is normally 4-6 cm/year. A growth velocity of 8 cm/year during the first year of therapy is considered a good response in pre-pubertal children.

In the second and third year of therapy, the rate may decrease to 7 cm/year, however, for children with a baseline growth velocity of < 4 cm/year, a growth velocity of 6 cm/year in the first year of treatment is still considered a good response.

The observations are consistent with results of a recent study showing rapid growth (up to 8-12 cm) in the first year of growth hormone therapy. Thereafter, growth velocity slows to a rate more closely matching natural growth.







References: i-growth.com.hk/growth-hormone-kids.html

It is not intended as medical advice to any specific person. If you have any need for personal advice or have any questions regarding your health, please consult your pediatric doctors for diagnosis and treatment.

Growth hormone therapy – growth hormone, growth hormone indications

Growth hormone therapy for short stature: Importance of first-year response
Should idiopathic short stature (ISS) treated?

ISS is severe short stature without a known cause, and includes children with short parents.

Being short has psychosocial implications and it is estimated that approximately 80 percent of all children referred for short stature, at the end of the diagnostic work−up, will be labeled as ISS. [J Pediatr 1994;125:29-35]

Short stature is referred to as having a height for age below the third percentile or below 2.5 percent to 3 percent of normal children. The number of children being treated for ISS in Hong Kong is very low. The cost of therapy and the fear of injections often deter patients.




Growth hormone indications

Long-term r-hGH therapy can lead to increased adult height in children with ISS. Growth hormone therapy is indicated for the treatment of ISS, defined by height standard deviation score (SDS) ≤−2.25, and associated with growth rates unlikely to permit attainment of adult height in the normal range, in pediatric patients whose epiphyses are not closed and for whom diagnostic evaluation excludes other causes associated with short stature that should be observed or treated by other means. [Arch Pediatr Adolesc Med 2004;158:108-110]

A randomized, placebo-controlled trial reported that a mean duration of 4.4 years of r-hGH treatment (0.2 mg/kg per week administered three times weekly) increased adult height outcomes by a mean of 3.7 cm. [J Clin Endocrinol Metab 2004;89:3140-3148]

Another study showed that use of a higher dosage of daily r-hGH (0.37 vs 0.24 mg/kg per week) increased the mean difference between measured and predicted adult height from 5.4 to 7.2 cm.[J Pediatr 2005;146:45-53]

The benefit of growth hormone therapy was confirmed in a review of trials on the impact of growth hormone treatment on adult height of children with ISS. The average adult height achieved by treated children exceeded that of untreated controls, from 0.57 to 0.70 SD score (3.4-4.2 cm). [BMJ 2011;342:c7157]







References: i-growth.com.hk/growth-hormone-indications.html

It is not intended as medical advice to any specific person. If you have any need for personal advice or have any questions regarding your health, please consult your pediatric doctors for diagnosis and treatment.