10 Possible Reasons Why Your Child Isn't Growing
Poor weight gain is a common problem for many children. This problem is usually noticed by parents, caregivers or primary care physicians who either notice that their child is not growing well or that their weight gain is deviating from the expected growth pattern.
When weight trends are not good, doctors may clinically consider the child to be "malnourished" or "failed to grow."
Why Your Child Isn't Growing
Dr. Radhakrishnan says there are many reasons why children can't reach the weight they need for healthy growth. These include:
1. Inadequate Calorie Intake
In 90% of cases, children aren't growing well because they aren't eating enough calories. This happens when children don't want to eat for various reasons or when parents don't understand how many calories their children actually need.
This can also happen to toddlers who are active and healthy but aren't very interested in eating.
For babies in the first few months of life, this can be caused by a low breast milk supply or improperly mixed formula.
2. Restricted Foods
Sometimes, caregivers themselves have mental health issues and may not be able to adequately feed the child. Or caregivers may accidentally make the formula too diluted. Some families may also experience food shortages.
Older children or teens may also not eat enough calories because they are struggling with body image issues due to a possible eating disorder (formerly known as anorexia nervosa).
3. Oral or neurological problems
If a child has oral sensitivity or neurological problems, they may also not be able to eat properly. These problems may affect their ability to swallow and may be caused by conditions such as cerebral palsy or cleft palate.
4. Vomiting
Sometimes a child cannot swallow formula or food because they vomit too much. This may be due to severe acid reflux or certain neurological problems and may lead to low muscle tone and various other conditions.
Most babies with acid reflux will probably get better and their growth will continue to proceed smoothly. Less commonly, however, young babies who vomit too much may develop a narrowing of the stomach outlet, called pyloric stenosis. This requires special evaluation, including an abdominal ultrasound.
5. Pancreatic problems
Children who cannot digest food properly may also have difficulty gaining weight due to a low pancreas function. In this case, children may have symptoms such as sticky, foamy, loose, foul-smelling, and greasy stools (like cystic fibrosis).
6. Gastrointestinal disorders
Diseases that affect the lining of the intestine, including celiac disease or Crohn's disease, can also cause children to have slow weight gain. Symptoms of celiac disease begin with foods containing gluten in the diet.
7. Thyroid and metabolic problems
In some cases, if a child has an overactive thyroid, they may burn too many calories.
8. Heart disease
If a child with a heart condition that causes heart failure has too much difficulty breathing, they may not be able to eat well.
9. Kidneys affect growth
Rarely, kidney failure or other kidney diseases can affect weight gain (as well as height).
10. Genetic disorders
In addition, some children may have various genetic disorders that affect weight gain and need to be evaluated by a specialist.
Bone age assessment plays a vital role in pediatric radiology, helping to determine a child's maturity and growth potential. X-ray imaging is often used to calculate bone age, providing valuable information for diagnosing various skeletal conditions, monitoring growth patterns, and assessing overall development.
Process of Calculating Bone Age Using X-rays
1. Patient Preparation: Before performing a bone age assessment, ensure that the patient is properly positioned and relaxed. It is critical to obtain high-quality X-ray images, so stabilizing the patient's hand and wrist may be necessary to reduce motion artifacts.
2. Imaging Technique: The standard imaging technique for bone age assessment involves obtaining an anteroposterior (PA) radiograph of the left hand and wrist. This projection allows for consistent visualization of the carpal bones, phalanges, and epiphysis.
3. Image Analysis: After obtaining the X-ray images, the radiographs are carefully analyzed to identify relevant anatomical structures. Key landmarks to consider include:
▸ Epiphyseal Plates: Assess the presence, size, and degree of fusion of the epiphyseal plates in the carpal bones and phalanges.
▸ Ossification Centers: Observe the ossification centers in each bone, noting their appearance and stage of development.
4. Reference atlases: Observed skeletal development is compared to established reference values using standard reference atlases, such as the Greulich-Pyle (GP) or Tanner-Whitehouse (TW) atlases. These atlases consist of radiographs corresponding to known ages, and bone age can be estimated by matching similar skeletal maturity patterns.
▸The GP atlas, developed by Greulich and Pyle in the 1950s, is based on radiographs of the left hand and wrist and provides a set of standards for each age group, allowing doctors to determine an individual's bone age by comparing their radiographs to the standard images.
▸The TW atlas, also known as the Tanner-Whitehouse-III (TW3) method, was developed in the late 1970s. It takes into account other skeletal features in addition to the hand and wrist bones to estimate bone age. The TW3 method is considered more accurate than the GP method, especially for older children.
5. Interpretation: Compare the ossification centers and epiphyseal plates identified in the patient's radiographic images with the corresponding reference images in the atlas. Based on similarity, estimate bone age by determining the closest match in skeletal maturity.
6. Reporting: Document your findings accurately and thoroughly in the radiology report. Include details about the patient, examination technique, key observations, estimated bone age, and any other relevant information.
