Glands and growth

When a Child is Unusually Short

​Short stature refers to any child who has a height well below what is typical for that child’s age and sex. The term is most commonly applied to children whose height, when plotted on a growth curve in the pediatrician’s office, is below the line marking the third or fifth percentile.

What is a growth chart?

A growth chart uses lines to display an average growth path for a child of a certain age, sex, and height. Each line indicates a certain percent- age of the population who would be that particular height at a particular age. If a boy’s height is plotted on the 25th percentile line, for example, this indicates that approximately 25 out of 100 boys his age are shorter than him. Children often do not follow these lines exact- ly, but most often, their growth over time is roughly parallel to these lines. A child who has a height plotted below the third percentile line is considered to have short stature compared with the general population. The growth charts can be found on the Centers for Disease Control and Prevention Web site at

What kind of growth pattern is atypical?

Growth specialists take many things into account when assessing your child’s growth. For example, the heights of a child’s parents are an important indicator of how tall a child is likely to be when fully grown. A child born to parents who have below-average height will most likely grow to have an adult height below average as well. The rate of growth, referred to as the growth velocity, is also important. A child who is not growing at the same rate as that child’s friends will slowly drop further down on the growth curve as the child ages, such as crossing from the 25th percentile line to the fifth percentile line. Such crossing of percentile lines on the growth curve is often a warning sign of an underlying medical problem affecting growth.

What causes short stature?

Although growth that is slower than a child’s friends may be a sign of a significant health problem, most children who have short stature have no medical condition and are healthy. Causes of short stature not associated with recognized diseases include

  • Familial short stature (One or both parents are short, but the child’s rate of growth is normal.)
  • Constitutional delay in growth and puberty (A child is short during most of childhood but will have late onset of puberty and end up in the typical height range as an adult because the child will have more time to grow.)
  • Idiopathic short stature (There is no identifiable cause, but the child is healthy.)

Short stature may occasionally be a sign that a child does have a serious health problem, but there are usually clear symptoms suggesting something is not right. Medical conditions affecting growth can include:

  • Chronic medical conditions affecting nearly any major organ, including heart disease, asthma, celiac disease, inflammatory bowel disease, kidney disease, anemia, and bone disorders, as well as patients of a pediatric oncologist and those with growth issues as a result of chemotherapy
  • Hormone deficiencies, including hypothyroidism, growth hormone deficiency, diabetes
  • Cushing disease, in which the body makes too much cortisol, the body’s stress hormone or prolonged high dose steroid treatment
  • Genetic conditions, including Down syndrome, Turner syndrome, Silver-Russell syndrome, and Noonan syndrome
  • Poor nutrition
  • Babies with a history of being born small for gestational age or with a history of fetal or intrauterine growth restriction
  • Medications, such as those used to treat attention-deficit/hyperactivity disorder and inhaled steroids used for asthma

What tests might be used to assess your child?

The best “test” is to monitor your child’s growth over time using the growth chart. Six months is a typical time frame for older children; if your child’s growth rate is clearly normal, no additional testing may be needed. In addition, your child’s doctor may check your child’s bone age (radiograph of left hand and wrist) to help predict how tall your child will be as an adult. Blood tests are rarely helpful in a mildly short but healthy child who is growing at a normal growth rate, such as a child growing along the fifth percentile line. However, if your child is below the third percentile line or is growing more slowly than normal, your child’s doctor will usually perform some blood tests to look for signs of one or more of the medical conditions described previously.

Glands and growth

When a Child is Abnormally Tall


Some children may be abnormally tall for their age from an early, rapid development of puberty or from an excess production of the growth hormone by the pituitary gland. These and other more rare conditions can stimulate growth, particularly of the jaw and the long bones of the arms and legs. Most of these conditions can be treated.

Early Growth Spurts & Precocious Puberty

Generally, growth spurts for girls start about two years earlier than growth spurts for boys. Children with precocious puberty experience early growth spurts because of the abnormally early rise in sex hormone levels in their bodies. Initially this causes these children to grow taller than other kids their age, but their skeletons mature more rapidly. Often this causes them to stop growing at an early age, and they end up being average or below average height as adults.

Too Much Growth Hormone (Hyperpituitarism)

Two conditions arise from excessive amounts of growth hormone in the body: acromegaly and gigantism.

  • Acromegaly is a condition in adults that is caused by an increased secretion of the growth hormone after normal growth has stopped. It is very rare. Because adults cannot grow taller, the excess growth hormone in acromegaly causes an adult’s bones to thicken and other structures and organs to grow larger.
  • Gigantism occurs when there is an excessive secretion of growth hormone in children before their normal growth has stopped. This results in overgrowth of the long bones. In addition to vertical growth in height, there is also growth in muscle and organs. The result is a person who is very tall, with a large jaw, large face, large skull, and very large hands and feet.

If You Have Concerns about Your Child’s Height

If you are concerned about your child’s height or think that your child may be growing too fast, talk to your pediatrician. If needed, your pediatrician can order further tests. A simple x-ray of the hand and wrist may show how much growth your child has left. Lab tests can also help find the cause of growth problems and how to treat them. You may also be referred to a pediatric endocrinologist, pediatric geneticist, or other pediatric specialist for further evaluation and treatment.

Glands and growth

Tips for Parents about Growth Hormone Injections

What is growth hormone treatment?

Growth hormone is a protein hormone that is usually made by the pituitary gland to help your child grow. After training, you will be giving your child an injection of recombinant growth hormone (rGH) every day, once per day. Recombinant means that this growth hormone shot is created in the laboratory to be identical to human growth hormone. Growth hormone has been available for treatment since the 1950s. However, rGH is safer than the original preparations, because it does not contain human or animal tissue.

What are the side effects of growth hormone treatment?

In general, there are few children who experience side effects due to growth hormone. Side effects that have been described include headache and problems at the injection site.

To avoid scarring, you should place the injections at different sites such as arms, legs, belly and buttocks. However, side effects are generally rare. Please read the package insert for a full list of side effects.

How is the dose of growth hormone determined?

The pediatric endocrinologist calculates the initial dose based upon weight and condition being treated. At later visits, the doctor will increase the dose for effect and pubertal stage.

The length of growth hormone treatment depends on how well the child’s height responds to growth hormone injections and how puberty affects this or her growth.

Glands and growth

Predicting a Child’s Adult Height

Parents often wonder how tall their toddler or preschooler might be when they grow up. Gradeschoolers and young teens may ask, “How tall will I be?” It is a natural question for parents and children, and besides being a little fun to try and predict how tall a child might be, pediatricians also find it helpful to make sure a child is growing as expected. While no one has a crystal ball, there are ways parents and pediatricians can make an educated guess. Read on.

How is a Child’s Adult Height Predicted?

The most accurate method of height prediction comes from using a child’s “bone age,” determined by an X-ray of the hand, but there are several methods you can use at home to get an idea of how tall your child will eventually become. The most common way to estimate a child’s adult height is to base it on the parents’ heights.

Two Years Times Two Method

Did you know the earliest growth spurt, from baby to toddler, actually accounts for roughly half of a child’s adult height? A simple method to predict adult height is to double the child’s height at age 2. Girls develop more quickly, so doubling their height at 18 months old can also be used as an estimate of how tall they will be as adults. While this method has been around for a long time, no research exists to demonstrate its accuracy.

Mid-Parental Method

A slightly more complex method of predicting your child’s height is known as the “mid-parental method.” Add together the measured heights of the mother and father in inches and divide by 2.

  • For a boy: add 2½ inches
  • For a girl: subtract 2½ inches

Note: This is just a very rough estimate of the average height of how tall a child will be when fully grown. You can expect a margin of error of about four inches up or down. The taller the parents, the taller the child is likely to be; similarly, the shorter the parents, the shorter the child.

Growth Charts

Regular measurements of a child’s height, weight and head size and plotting them on a growth chart are a good way to see if your child is growing as expected. Pediatricians use standardized growth charts at each well-child visit. What many people don’t realize is that growth charts are also helpful for judging the onset of puberty in an older child. As you may know, puberty is occurring at an earlier age these days. The onset of pubic hair or breast budding in girls can occur normally as early as age six! Growth charts can help pediatricians determine whether your child’s early development is in the normal range.

Family History & Genetics

Height and growth patterns usually run in families. Your child’s pediatrician may ask about your own height, since your genetic make-up is the biggest factor in how your children grow. You may also be asked how tall other family members are. Additionally, you may be asked how fast and at what age you grew during your childhood (i.e. your growth pattern). Were you short in grade school but kept growing after all of your friends stopped? Did you go through puberty early or late? These may be important clues for your child’s pediatrician.

What Else Affects Your Child’s Height?

While genes play a huge part in predetermining how tall your child will be (e.g. short parents usually have short children) other factors have an impact on how much your child grows. These include:

  • Nutrition: A child who is overweight is often taller than classmates, although that does not necessarily mean that he will be taller as an adult. Children who are very underweight might be shorter than expected for age.
  • Hormones: Hormone imbalances, such as low thyroid or growth hormone levels, lead to slower than expected growth and can result in children who are either shorter or taller than would be expected if not diagnosed and treated. Review red flags to help you tell if your child is growing normally and will reach his predicted height or if he might have a growth hormone problem.
  • Medications: Some medications, particularly chronic use of corticosteroids (like prednisone), can slow growth.
  • Health conditions: Children with some chronic illnesses, such as severe arthritis, untreated celiac disease, or cancer may be shorter than expected.
  • Genetic conditions: Children with some genetic conditions can cause either short or tall stature. For example, those with Down Syndrome, Noonan Syndrome, or Turner Syndrome tend to be shorter than other family members, while Marfan Syndrome can cause someone to be taller. 

Additionally, exercise, pollution, sleep patterns, climate, fitness, diet, and psychological well-being can also impact growth.

If You Have Concerns about Your Child’s Height:  

If you are concerned about your child’s height or think that your child may be growing too fast or too slowly, talk to your pediatrician. If needed, your pediatrician can order further tests. A simple x-ray of the hand and wrist may show how much growth your child has left. Lab tests can also help find the cause of growth problems and how to treat them. You may also be referred to a pediatric endocrinologist, pediatric geneticist, or other pediatric specialist for further evaluation and treatment.

Don’t delay!

Remember, once your child finishes puberty, growth stops. A short teenager has little or no time to catch up on growth, while a younger child still has time to be treated and grow taller.

Glands and growth

How to Read a Growth Chart: Percentiles Explained

​When you go to the pediatrician for a well-child check, you’ll always review your baby’s or child’s growth. It’s probably the most important piece of data your pediatrician gets. The reason is, it can capture so much about your child’s vitality.

Growth Chart Downloads:

WHO Growth Charts

  • Birth to 24 Months: Boys Weight-for-length and Head circumference-for-age percentiles
  • Birth to 24 months: Boys Length-for-age percentiles and Weight-for-age percentiles
  • Birth to 24 Months: Girls Weight-for-length and Head circumference-for-age percentiles
  • Birth to 24 months: Girls Length-for-age percentiles and Weight-for-age percentiles

CDC Growth Charts

  • Children 2 to 20 years: Boys Stature-for-age and Weight-for-age
  • Children 2 to 20 years: Boys BMI-for-age
  • Children 2 to 20 years: Girls Stature-for-age and Weight-for-age
  • Children 2 to 20 years: Girls BMI-for-age

First 3 Years – A Major Growth Period

In the first 3 years, we use one growth chart that looks at the head’s circumference and the weight and length. It’s based on gender and lots of data. We watch for changes in the size of head circumference in infancy because we want to know that the brain is growing. Growth grids have been used since the 1970s, but back in 2000, they were revised to really reflect different cultural and ethnic diversities that exist within our population.

Why Percentiles Are Not Like the Grades in School

What we want from a growth grid is to really map out the ideal growth for children. This isn’t like grades in school. When your child comes in at the 10th percentile, it’s really no better or worse than coming in at the 90th. What we care about most is the trend at which your baby or child gains weight, height, or head circumference.

After age 2, you can use the growth chart to expand between the ages of 2 and 20. In addition to weight and height at that point, we also look at body mass index, that number where we try to capture how children’s proportionality is. Are they at risk for overweight or are they too lean?

Everything from genetics, to environment, to nutrition, to activity, to health problems really influence how your child grows. Why we review it each time is to talk about threats to your baby’s or child’s health and ways that you can take great opportunity to make changes.

How to Follow the Grid:

When you’re looking at a growth grid, what you want to focus on is how your child is changing. One static point on the growth grid isn’t as relevant as 5 data points over time. You want to know rates at which your baby or child is growing and the rate compared with the grid.

As you follow the grid along from infancy into toddlerhood, you’ll notice that each time it will rise. Each data point at each set of time will increase. We care about the rate at which your baby or child grows, not the number.

Why You Shouldn’t Focus on the Number:

Parents often come in to the office and say, “What percent is she at?” She might be at the 13th percentile; that might be phenomenal based on where she’s been previously, or it might be concerning. Don’t focus on the number. Have your pediatrician, family doctor, or nurse practitioner help you understand what the trends are for your baby’s growth.

Parents, pediatricians, and nurses have been using growth charts since the late 1970s to track growth in infants and children. The charts were revised back in 2000 as data for the first charts (from a small study in Ohio) didn’t accurately reflect the cultural and ethnic diversity of our communities.

The Hallmark of the Well-Child Check:

The hallmark of a well-child check is the review of a child’s growth. Growth can be a reflection of a child’s overall health, nutrition, or tolerance of possible underlying medical conditions. So understanding what your doctor or nurse practitioner says about your child’s growth should be a priority.

If your doctor doesn’t have a computer in the examination room, ask to see the chart on paper or on a computer in the office. It will not only inform you, I suspect it will delight you to see what your child has done since the last time he was seen. The human body really is a fine-tuned machine, and growth is simply astounding if you really stop to think of it. It’s true your baby will at least double his weight by 6 months and triple it by about 1 year of age.

If You Have Questions:

If you have a challenge understanding how your child is growing or how the growth chart is presented, demand clarification. It’s OK if you don’t understand the presentation of facts on these grids; have confidence to speak up and ask the doctor or nurse practitioner to explain it.

Glands and growth

Growth Problems in Adopted Children

Occasionally, children adopted from other countries may have slow growth and developmental delays from inadequate care and nutrition. These children may need special help and more calories than usual to catch up to a level that fits their age. Adoption agencies can put parents in touch with support groups for those in similar situations. Your pediatrician will help with advice and referrals to specialists if they’re required.

Glands and growth

Growth Hormone Deficiency FAQs

​​​What is growth hormone deficiency?

Growth hormone deficiency is a rare cause of growth failure in which the child does not make enough growth hormone to grow normally. Growth hormone is one of several hormones made by the pituitary gland, which is located at the base of the brain behind the nose.

How frequent is growth hormone deficiency?

Estimates vary, but it is rare. The incidence is less than 1 in 3,000 to 1 in 10,000 children.

What causes growth hormone deficiency?

There are many causes of growth hormone deficiency, most of which are present at birth (called “congenital”) but may take several years to become apparent or it can develop later (called “acquired”). Congenital causes include genetic or structural abnormalities of the development of the pituitary gland and surrounding structures, while acquired causes, which are much less common, can include head trauma, infection, tumor, or radiation.

What are signs and symptoms of growth hormone deficiency?

Children with growth hormone deficiency are usually much shorter than their peers (that is, well below the 3rd percentile line) and over time, they tend to drop farther and farther below the normal range. It is important to note that growth hormone-deficient children are usually not underweight for their height; in many cases, they are on the pudgy side, especially around the stomach.

How is growth hormone deficiency diagnosed?

Evaluation of a child with short stature and slow growth pattern may include a bone age x-ray (x-ray of the left wrist and hand) and various screening laboratory tests. The diagnosis of growth hormone deficiency cannot be made on a single random growth hormone level, because growth hormone is secreted in pulses. Some pediatric endocrinologists diagnose growth hormone deficiency based on an extremely low level of insulin-like growth factor 1 (IGF-1), which varies much less in the course of the day than growth hormone. IGF- 1 levels are dependent on the amount of growth hormone in the blood but can also be low in normal, young children, so the test must be interpreted carefully.

A more accurate but still imperfect way to diagnose growth hormone deficiency is a growth hormone stimulation test. In this test, your child has blood drawn for about 2 to 3 hours after being given medications to increase growth hormone release. If the child does not produce enough growth hormone after this stimulation, then the child is diagnosed with growth hormone deficiency. However, growth hormone stimulation tests can over diagnose growth hormone deficiency. Growth hormone stimulation tests vary and are complicated, so they are usually performed under the guidance of a pediatric endocrinologist. Usually, other tests to check the pituitary or to evaluate the brain (MRI) are performed when treatment is considered.

How is growth hormone deficiency treated?

The treatment for growth hormone deficiency is administration of recombinant human growth hormone by subcutaneous injection (under the skin) once a day. The pediatric endocrinologist calculates the initial dose based on weight, and then bases the dose on response and puberty. The parent is instructed on how to administer the growth hormone to the child at home, rotating injection sites among the arms, legs, buttocks, and stomach. The length of growth hormone treatment depends on how well the child’s height responds to growth hormone injections and how puberty affects the growth. Usually, the child is on growth hormone injections until growth is complete, which is sometimes many years.

What are the side effects of growth hormone treatment?

In general, there are few children who experience side effects from growth hormone. Side effects that have been described include severe headaches, hip problems, and problems at the injection site. To avoid scarring, you should place the injections at different sites. However, side effects are generally rare. Please read the package insert for a full list of side effects.

How is the dose of growth hormone determined?

The pediatric endocrinologist calculates the initial dose based on weight and condition being treated. At later visits, the doctor will change the dose for effect and pubertal stage and sometimes based on IGF-1 blood test results. The length of growth hormone treatment depends on how well the child’s height responds to growth hormone injections and how puberty affects growth.

What is the prognosis for growth hormone deficiency?

Growth hormone usually results in an increase in height for growth hormone-deficient individuals, as long as the growth plates have not fused. The reason for the growth hormone deficiency should be understood, and it is important to recheck for growth hormone deficiency when the child is an adult, because some children no longer test as if they are growth hormone deficient when they are fully grown.

Glands and growth

Failure to Thrive

At each of your child’s checkups, your pediatrician’s office should plot your child’s weight and measurements. In general, you should see a continuous upward trend, although there will be times when she gains very slowly and perhaps some weeks when she actually loses a little weight due to illness. It is not normal for her to stop growing or to lose weight except for the small amount she loses during the first few days of life. If she does lose weight, it is a clear sign either that she is not getting enough to eat or that she is ill. The medical term for this condition is failure to thrive. Although it can happen in older children who are seriously ill or undernourished, it is most common and most dangerous during the active growth period of the first three years.

If allowed to continue for a prolonged period, this condition can become serious. Steady weight gain is especially important for infants and toddlers because it means that they are receiving adequate nutrition and care for normal physical, mental, and emotional development.

Usually when a child stops growing, it is due to a feeding problem that prevents her from getting as many calories as she needs. As a newborn, she may be too fussy to eat as much as she needs, or, if breastfed, she may not be getting enough milk while nursing. Some children may require more food than their parents are able to provide. These problems must be detected and treated early in order to avoid long-term or permanent damage.

Sometimes failure to thrive signals a medical problem. The newborn may have an infection passed on from her mother during pregnancy, or she may have a hormonal difficulty, an allergy, or a digestive problem that prevents nutrients from being absorbed into the body properly. Diseases such as cystic fibrosis, diabetes, or heart disease also can interfere with normal growth. If one of these is present, the child may need a special diet as well as medical treatment.

When to Get Help

Regularly charting your child’s growth, and comparing her general development with others her age, are the best ways to make sure she is thriving. If she does not gain weight, grow in length, or otherwise develop normally, consult your pediatrician. He will measure and examine your child, ask about her diet and eating patterns, and review her medical history for signs of illness that may be contributing to her failure to thrive. The physician will try to establish exactly when the growth or weight gain stopped, and ask about anything that may have contributed to this. The pediatrician also may watch your child eating or nursing to see how much she consumes and how she responds to food. Sometimes a short period of in-hospital observation may be necessary.

If the doctor discovers a physical cause for the decrease in growth rate, he will recommend the appropriate treatment. If there is no physical reason, however, the pediatrician will look for emotional or social problems, particularly within the family. Such disturbances can decrease a child’s appetite or alter her normal food intake and digestion. Once discovered, these difficulties can be treated with individual or family counseling.

Glands and growth

Congenital Hypothyroidism in Infants

​What is congenital hypothyroidism?

Hypothyroidism refers to an underactive thyroid gland. Congenital hypothyroidism occurs when a newborn infant is born without the ability to make normal amounts of thyroid hormone. The condition occurs in about 1 in 3,000-4,000 children, is most often permanent and treatment is lifelong.

Thyroid hormone is important for your baby’s brain development as well as growth, therefore, untreated congenital hypothyroidism can lead to intellectual disabilities and growth failure. However, because there is excellent treatment available, with early diagnosis and treatment, your baby is likely to lead a normal, healthy life.

What causes congenital hypothyroidism?

Congenital hypothyroidism most often occurs when the thyroid gland does not develop properly, either because it is missing, is too small, or ends up in the wrong part of the neck. Sometimes the gland is formed properly but does not produce hormone in the right way. Also, sometimes the thyroid is missing the signal from the pituitary (master) gland, which tells it to produce thyroid hormone.

In a small number of cases, medications taken during pregnancy, mainly medications for treating an overactive thyroid, can lead to congenital hypothyroidism, which is temporary in most cases. Congenital hypothyroidism is usually not inherited through families. This means if one child is affected, it is unlikely that other children you may have in the future will suffer from the same condition.

What are the signs and symptoms of congenital hypothyroidism?

The symptoms of congenital hypothyroidism in the first week of life are not usually obvious. However, sometimes when hypothyroidism is severe, there may be:

  • Poor feeding
  • Excessive sleeping
  • Weak cry
  • Constipation
  • Prolonged jaundice (yellow skin) after birth

In these babies, the doctor may find a puffy face, poor muscle strength, and a large tongue with a distended abdomen and larger-than-normal fontanelles (soft spots) on the head.

How is congenital hypothyroidism diagnosed?

Given the difficulty in diagnosing congenital hypothyroidism in the newborn period based on signs and symptoms, all hospitals in the United States, under the supervision of state health departments, screen for this disease using blood collected from your baby’s heel before discharge from the hospital. This process is called newborn screening. See the American Academy of Pediatrics (AAP) policy statement, Update of Newborn Screening and Thereapy for Congenital Hypothyroidism, for more information. 

When there is a positive result (a low level of thyroid hormone with a high level of thyroid-stimulating hormone, called TSH, from the pituitary), the screening program immediately notifies the baby’s doctor, usually before the baby is 2 weeks old. Before starting treatment, your baby’s doctor will order a blood sample from a vein to confirm the diagnosis of congenital hypothyroidism. In some cases, the doctor may order a thyroid scan to see if the thyroid gland is missing or too small.

What is the treatment for congenital hypothyroidism?

Congenital hypothyroidism is treated by giving thyroid hormone medication in a pill form called levothyroxine. Many children will require treatment for life. Levothyroxine should be crushed and given once daily, mixed with a small amount of water, formula, or breast milk using a dropper or syringe.

Giving your baby his or her thyroid hormone EVERY DAY and having regular checkups with a pediatric endocrinologist will help ensure that your baby will have normal growth and brain development. Your doctor will do periodic thyroid function tests so that the dose of medication can be properly adjusted as your child grows.

The hormone in the pill is identical to what is made in the body, and you are just replacing what is missing. In general, side effects occur only if the dose is too high, which the endocrinologist can avoid by checking blood levels on a periodic basis.

Glands and growth

Acquired Hypothyroidism in Children

​​​What does hypothyroidism mean?

Hypothyroidism refers to an underactive thyroid gland that does not produce enough of the active hormones T3 and T4. This condition can be present at birth or can be acquired any time during childhood or adulthood. Hypothyroidism is very common and occurs in about 1 in 1,250 children. In most cases, the condition is permanent and will require treatment for life.

About the thyroid gland:

The thyroid gland is a butterfly-shaped organ located in the middle of the neck. It is responsible for producing the thyroid hormones T3 and T4. This production is controlled by the pituitary gland in the brain via thyroid stimulating hormone (called TSH). T3 and T4 perform many important actions during childhood, including the maintenance of normal growth and bone development. Thyroid hormone is also important in the regulation of metabolism.

What causes acquired hypothyroidism?

The causes of hypothyroidism can arise from the gland itself or from the pituitary. The thyroid can be damaged by direct antibody attack (autoimmunity), radiation, or surgery. The pituitary gland can be damaged following a severe brain injury or secondary to radiation. Certain medications and substances can interfere with thyroid hormone production. For example, too much or too little iodine in the diet can lead to hypothyroidism. See the American Academy of Pediatrics (AAP) policy statement, Iodine Deficiency, Pollutant Chemicals, and the Thyroid: New Information on an Old Problem, for more information.

Overall, the most common cause of hypothyroidism in children and teens is direct attack of the thyroid gland from the immune system. This disease is known as autoimmune or Hashimoto’s thyroiditis.

Who is at the greatest risk?

Certain children are at greater risk of hypothyroidism; this includes children with congenital syndromes, especially Down syndrome, children with type 1 diabetes, and children who have received radiation for cancer treatment.

What are the signs and symptoms of hypothyroidism?

The signs and symptoms of hypothyroidism include:

  • Tiredness
  • Modest weight gain (no more than 5-10 lb)
  • Feeling cold
  • Dry skin
  • Hair loss
  • Constipation
  • Poor growth

Often, your doctor will also be able to palpate an enlarged thyroid gland in the neck. This is called a goiter.

How is hypothyroidism diagnosed?

Simple blood tests are used to diagnose hypothyroidism. These include the measurement of hormones produced by the thyroid gland and pituitary. Free T4 (which is more accurate than just the total T4) and TSH are measured. The tests are inexpensive and widely available at your regular doctor’s office. Hypothyroidism is diagnosed when the stimulating hormone from the pituitary (TSH) is high and the free T4 produced from the thyroid is low. If there is not enough TSH, then both levels will be low. Normal ranges for free T4 and TSH are somewhat different in children than adults, so the diagnosis should be made in consultation with a pediatric endocrinologist.

What is the treatment for hypothyroidism?

Hypothyroidism is treated using a synthetic thyroid hormone called Levothyroxine. This is a once-daily pill that is usually given for life. There are very few side effects, and when they do occur, it is usually the result of significant overtreatment. Your doctor will prescribe the medication and then perform repeat blood testing. We wait at least 6-8 weeks, because it takes a long time for the body to adjust to the new hormone levels. If the medication is working, blood testing will show normal levels of TSH and free T4.

You should contact your doctor if your child experiences difficulty falling asleep or restless sleep or difficulty concentrating in school. These may be signs that your current thyroid hormone dose may be too high and you are being over treated.

There is no cure for hypothyroidism; however, hormone replacement is safe and effective. With once-daily medication and close follow-up with your pediatric endocrinologist, your child can live a normal, healthy life.