Medicines for Restricted growth

What it is

Restricted growth (also called short stature, and sometimes dwarfism) is a term used when a person is significantly shorter than the average for their age and background. It is not a single condition but can result from a range of different causes, which are broadly grouped in two ways. Proportionate short stature is where the body is small but the parts are in proportion to each other; this can be due to causes such as being born small, poor growth in childhood from various causes (for example some medical conditions, nutritional factors, or hormone-related causes such as growth hormone deficiency), or as a familial trait. Disproportionate short stature is where some parts of the body are smaller than others (for example the limbs are shorter relative to the trunk, or vice versa); this is usually due to genetic conditions that affect the growth of the bones (skeletal dysplasias), the most common of which is achondroplasia. The cause affects the pattern, the health implications (if any), and the care. It is very important to understand and emphasise that restricted growth is a physical characteristic, and that people with restricted growth are as able and lead lives as full as anyone else — the focus of care is on any specific health needs associated with the underlying cause (which vary greatly, and which many people with restricted growth do not have significant problems with), and on support, adaptations, and ensuring the person can participate fully, rather than on the height itself as a "problem" to be fixed. For some causes, there may be specific health considerations to monitor or manage (particularly with some of the skeletal conditions, or hormone-related causes), and, for some specific causes (such as growth hormone deficiency), treatment may be available and appropriate. But for many people, restricted growth is simply a characteristic, and care focuses on wellbeing, any specific needs, adaptations, and support, alongside respect and inclusion. The key messages are that restricted growth is significant short stature from a range of causes, that people with restricted growth lead full lives, and that care is focused on any specific health needs associated with the cause, and on support, adaptations, and inclusion.

How it is treated

Restricted growth is managed by understanding and, where relevant, treating the underlying cause, monitoring and managing any specific health needs associated with it, and providing support, adaptations, and inclusion — with a strong emphasis on the person leading a full life; care depends greatly on the cause. Because restricted growth has many possible causes, an important part of care is understanding the underlying cause, which may involve assessment and tests (such as measuring and monitoring growth, examination, blood tests including for hormones, X-rays or genetic testing for skeletal conditions, and other investigations), guided by specialists (such as paediatricians, endocrinologists, and genetic specialists), particularly in childhood; this identifies the cause, any health implications, and whether any treatment is relevant. Management then depends on the cause. For some causes, specific treatment may be available and appropriate — for example, for growth hormone deficiency, growth hormone treatment can be given; and other specific causes are treated as relevant. However, for many causes (particularly the genetic skeletal conditions such as achondroplasia), the short stature itself is a characteristic rather than something to be "treated", and care focuses on other aspects. A key part of care is monitoring for and managing any specific health needs associated with the underlying cause — which vary greatly between causes: some conditions (particularly some skeletal dysplasias) have specific health considerations (for example relating to the spine, joints, ears, breathing, or other areas) that are monitored and managed as needed, while many people with restricted growth do not have significant health problems. Supporting the person to lead a full life is central — including practical support and adaptations (for example, adaptations at home, school, and work to accommodate height where helpful), support for wellbeing, confidence, and inclusion, and addressing any social or emotional aspects (as people with restricted growth may face challenges such as others’ attitudes, which support can help with). Respect, inclusion, and avoiding treating the person’s height as a problem are important. Support for the person and family, and connecting with support organisations (such as those for restricted growth and specific conditions), which provide information, advice, community, and advocacy, are valuable. Care continues over time, tailored to the person’s needs and any health considerations. The reassuring and respectful messages are that restricted growth is a physical characteristic with many possible causes, that people with restricted growth lead full lives, that care focuses on understanding and, where relevant, treating the cause, monitoring and managing any specific health needs, and providing support, adaptations, and inclusion, and that respect and support are central; so understanding the cause, managing any specific health needs, and support, adaptations, and inclusion are the keys.