Could it be pediatric growth hormone deficiency?

pGHD is a rare condition in which a child's body doesn't produce enough growth hormone—a key factor in stimulating growth, particularly in bones and muscles. If your daughter has less growth hormone than what is typical for her age, it could have lasting effects on her health.

Common signs and symptoms of pGHD include slow growth (growing less than 2 inches a year after age 3 until puberty), being shorter and looking younger than children the same age, low blood sugar, delayed bone growth, teeth that come in late, fine hair, poor nail growth, chubby midsection, and high-pitched voice.

Your daughter's pediatrician and/or pediatric endocrinologist will conduct a thorough evaluation, which may include physical exams, growth measurements, blood tests, imaging studies, and genetic testing to confirm or rule out pGHD.

Your healthcare provider may use growth charts to track your child's growth over time. If there's a noticeable decline in her growth pattern, it'd be appropriate to test for low levels of growth hormone. Use the Growth Calculator to find her current height percentile.

A growth hormone stimulation test, also known as a "stim test," checks whether the body makes enough growth hormone by drawing blood multiple times over the course of a few hours. A stim test is a key part of diagnosing pGHD and can help determine whether growth hormone therapy will help.

Growth hormone is released in pulses throughout the day, so it needs to be measured multiple times to accurately assess peak levels.

Your doctor will determine what tests are necessary; however, in some cases, imaging studies like an MRI may be used to examine your child's pituitary gland, which is responsible for making growth hormone.

X-rays of your child's hand and wrist may be taken to assess bone age, which can help estimate the amount of growth they have remaining.

If left untreated, pGHD may lead to delayed puberty, reduced bone density and muscle mass, and high cholesterol.

Because every girl's journey is unique, and different bones stop growing at different times, it's hard to say when growth plates will close exactly. However, on average, girls stop growing around age 13 to 15. The earlier your daughter starts treatment, the more time she has to grow before her growth plates close.

While most cases of pGHD are due to unknown causes, genetic testing may be performed to identify any underlying genetic causes of pGHD. The results of a genetic test can also confirm or rule out a condition or help determine your daughter's chance of developing or passing on a genetic disorder.

A pediatric endocrinologist specializes in the diagnosis and management of hormonal disorders in children, including growth-related issues. Use the Specialist Finder to find a pediatric endocrinologist near you.

You may have heard "she's just petite," "girls don't grow as fast," "she's always been small," "her mom was tiny too," or "she's a late bloomer." These assumptions, held up by parents, providers, and society at large, may prevent girls from being tested for conditions like pGHD and receiving the treatment they need to help them grow.

For a full list of questions and tips on how to advocate for your daughter, download the Discussion Guide. You can print it out and take it with you to your next appointment to help start a conversation about pGHD.