Kid not growing

[StudioBox]

Hi,
We have a family that we sponsor through our association in Nepal. They are financially weak and during our last visit, one of the kids in the family is having trouble growing.
He will be 5 years old in October 2018 and he barely weighs 17 pounds and is 26 inches tall. At first everybody thought we was a dwarf but his bone structure and his head is different from a dwarf. His testicles are hidden (have not dropped).
The family took him to many doctors and their diagnosis was that he was not producing growth hormones. His chest has protruded and he cannot eat much. These days whatever he eats, he vomits it.
The only solution the doctors gave the family is injection of growth hormones. The parents of the kid are very scared to try this as they think the side effect of injecting growth hormone to such a small kid can be fatal.
What do you guys think? Is there any other medical procedure that I can advise this family to seek? Is there a pediatrician who can give his/her advice?

Hi im new on here..not sure if i can help much but i remember someone in our neighbourhood who had the same situation needed the growth injection. Shes not highely tall now still short but ok. In that dep the peadatricians should be able to suggest the effevtiveness and sfaety of it or you can do some research into the drug.

Another holistic approach would be his body isnt processing foods properly nor is it absorbing nutrients fully. Give him high level probiotics as well as Bovine colustrum fresh pasturised or powder form to help heal his gut. All issues start within a weak gut. Hope that helps. X

Thank you for your answer.
Since his testicles have not dropped, the doctors have concluded that it is not creating growth hormones.
We are very worried about this kid's health and he is not doing very well.

Growth Hormones should not cause any side effects as they are naturally produced by the body but there are some rare side effects which can cause bleeding on the brain.

Babies are also given growth hormones so a 5 year old will not be the youngest on them by far.

Thank you Reaa for your reassurance. Since this 5 year old is barely 2 feet tall, his parents are worried that his little body would not be able to cope with the side effects of growth hormone injections.

The parents were also suggested to get the kid's testicle operated.

The operation is quite simple for that I believe.

The dosage they start the DC on will be a low dosage and then gradually build it up to the full dosage for someone of his current weight and height and I believe, the dosage will then increase with age.

My 4 year old is the same size as a normal 18 month old (is about 2 feet 10 inches) and is on growth hormone and has been for over a year. It's perfectly safe and my son has experienced no side effects. I think side effects are fairly rare tbh.

Hi Babaroll,
Has the hormone worked? And do you have the name of it please?

Yes it's working, he's grown 10cm in the last year and is gradually catching up to the bottom of the charts. He's on norditropin but there are many variants of the same medication (somatropin) under different brands.

I'd suggest he needs a full pituitary work up, rather than just focusing on his growth. Gh injections are also a daily injection until the child stops growing, full training is needed plus you need to consider he storage of equipment and drug (most need to go in the fridge) - it is also very costly..... pm me if you need more info and background

I cannot see how the GH would help without doing something to improve his nutrition first. He's off the scale tiny for a 1 year old, hardly eating anything, and vomiting most of that? Whilst weighing the pros and cons of the GH, for pity's sake get a lower tech (and probably cheaper) assessment of his guts done first.

We cannot tell, from the tiny bit of info you give us, what is wrong with him. But an absolute core underpinning of assessment and treatment of failure to thrive is that if you're not getting the calories in, you can't make progress.

Nocoolnamesleft,
The kid is very tiny even though he is almost 5. His limbs look like of a 2 year old. He used to eat fine. Of course not the amount that a 5 year old should eat but that is because he is very small. Recently he cannot even eat the same amount he used to eat 5 months ago. His mid-section (chest to lower abdomen) is protruding.

I don't think it is related to nutrition as he eats what every other kid does in his country.

Here's his pic.

Hi woofsaidtheladybird,
I am not being able to PM you.
Your talked pituitary gland. Does that mean that he needs a head surgery? Or is it something that can be treated with medication?

You misunderstand me. I don't mean he's small because of malnutrition. And I certainly don't mean they're not feeding him. I mean that whatever underlying condition he has is also screwing up his ability to tolerate nutrition. And you absolutely have to be able to get enough calories in for the GH to work. Even if he is GH deficient, and even if GH is part of the right treatment, if they don't find a way for him to cope with enough calories to grow it won't get anywhere.

But diagnosing him would require:
A very detailed history
A decent examination
Developmental assessment
Extensive xrays
A variety of scans
Lots of bloods, urine samples etc for metabolic, endocrine, and genetic disorders
Input by at least a geneticist, a paediatric endocrinologist, a paediatric gastroenterologist, a paediatric orthopaedic doctor, a paediatric radiologist, a really good paediatric dietician. And quite probably also paediatric surgery, and maybe spinal surgery and cardiothoracics.

In the UK, he wouldn't just be at a children's hospital (ie local DGH would not be able to work this out), but probably at least being discussed by them with GOS.

I'm afraid the odds of us being able to actually help over the internet is pretty minimal, because (as the GMC would put it) we cannot put ourselves in the position to properly assess the patient. With a 3rd hand history, no examination, and no results. Hence going back to the basics of any intervention made to try to promote growth has to include sorting out calorie intake, as that is true for any cause.

Totally agree with the above poster.
'Head surgery' is rather jumping the gun a bit!! The pituitary gland is in the brain, and controls the hormones and their effects on the glands.
It is difficult to assess with the little information you have given.
With your concern, I would suggest a referral to a Paediatrician who will then commence the diagnostic work up

As nocoolnamesleft said above something like this takes a whole group of different doctors, consultants and specialist trained nurses to diagnose and to treat and this is a long term thing.

He would properly been on the growth hormones for the next 11 years and the cost is very expensive per vial, which may only last 5-6 days depending on dosage.

I think the growth hormone discussion needs to be put on hold until DRs have figured out what is causing the vomiting.

I personally don't think the two issues are linked. (And that was my own personal view not from a medical point of view)

Thank you all for your advice. I will ask the family to do a thorough check-up before accepting to inject growth hormone.
But I think one of the first things to do would be to operate his testicles to get it down.

Well you need to find out why they aren't down, and it could be pituitary driven. Don't rush into surgery without full medical work up first!