Little children

Our son J. is quite small for his age. At age 3 he was barely three feet tall, which puts him just above the lower 5th percentile of the growth chart. Although he was born normal, his height and weight dropped into the low 5-10 percentile within the first half year of his life and have been there ever since. Even though he is not extremely short (that would start below the third percentile), I do worry about his physical development.

From what I understand, a slow growth is not uncommon in atopic children [1,2], and the severity of the eczema seems to have an influence on the impairment of growth [4]. But it is not at all clear why this happens. Growth is controlled by the growth hormone, and it seems that growth hormone production is impaired in atopic children [3]. The disruption of sleep (that’s where most of the growth hormone is produced) and the chronic inflammation could all have an influence on this hormonal deficiency. Other hypothesis discuss that gastrointestinal abnormalities or inappropriate dietary restrictions could cause malnutrition [2], and strong dosages of cortisone can affect growth as well [1].  Or it could be due to something entirely different which is not understood in atopic children. In other words, it is pretty much a mystery why atopic children tend to be small.

Unfortunately, I am no expert in all those hormonal cascades, so I don’t understand most of the suggested explanations why this impairment of growth is happening. But what I do understand is that most children will catch up with a delayed growth spurt in adolescence, and that growth is not in general impaired but merely delayed [5]. So there is hope that J. will not be the shortest guy around during his whole life…. But nevertheless we should make an effort to rule out all causes that can impair growth other than atopy.

We have a large university hospital not too far away from us with a quite good dermatological clinic that, so I now learned, offers special consultation for atopic patients. I made an appointment for J. for next month. I hope that will be helpful.

References:

[1] David J. Atherton (1994) Eczema in childhood. The facts. Oxford Medical Publications, Oxford University Press.

[2] Ring J, Przybilla B and Ruzicka T (Eds.) (2006). Handbook of Atopic Eczema. Springer-Verlag Berlin Heidelberg. (available as electronic version online)

[3] Ferguson, AC, Murray, AB, Tze, WJ (1982). Short stature and delayed skeletal maturation in children with allergic disease. J. Allergy Clin. Immunol., 69, 5:461-6.

[4] Agostoni, C, Grandi, F, Scaglioni, S, Giannì, ML, Torcoletti, M, Radaelli, G, Fiocchi, A, Riva, E (2000). Growth pattern of breastfed and nonbreastfed infants with atopic dermatitis in the first year of life. Pediatrics, 106, 5:E73.

[5] Ellison, JA, Patel, L, Kecojevic, T, Foster, PJ, David, TJ, Clayton, PE (2006). Pattern of growth and adiposity from infancy to adulthood in atopic dermatitis. Br. J. Dermatol., 155, 3:532-8.

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One Response to Little children

  1. Spanish Key says:

    Hey, I’m atopic, and normal-sized. So’s my sister. My atopic cousin is a giant, a truck driver. I hadn’t heard of any connection. Based on my anecdotal experience, it’s not a worry. My non-atopic dad, however–he’s the short man!

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