Not All Small Children Are the Same

If there have been days when your child looked smaller than other kids

Key points in 30 seconds

1. The biggest factor in a child's final height is genetics. The predicted range calculated from the parents' heights is the starting point of a consultation, and no treatment has evidence that it can push a child beyond that range.
2. So growth care means helping a child grow as much as they naturally can. It's about finding and removing what eats into that potential.
3. Not all small children are the same. Late growers, children held back by an illness, and children growing too fast: the three have completely different paths.
4. The last two are hard to reverse if you miss the timing. That's why the first step isn't a prescription but sorting out which group your child is in.
5. Herbal medicine isn't a "medicine that makes you taller." The size of the effect confirmed in research was 0.29 cm over 6 months. We don't inflate this number.

What we often hear

• "My child has been in the front row of the class for years. I'm worried they'll stay small."
• "There are so many things that are supposed to help. I don't know what to believe."
• "Is this the time to do something, or is it OK to wait?"
• "Actually, my child seems to be growing too fast, and that worries me more."
• "There's nowhere good to ask, so I just search online every night."

Parents who come in for growth consultations have one thing in common. They're worn out not because there's too little information but because there's too much.

And they already know that most of that information is a promise made to sell something.

So this article isn't about promises. It's about the right order of steps.

How much of height is inherited?

There's something we need to acknowledge first.

The biggest factor in a child's final height is genetics. That's why the predicted range calculated from the parents' heights is the starting point for a growth consultation.

And no treatment has evidence that it can push a child beyond this potential. We won't tell you that either.

So what does growth care actually do?

This isn't about giving up.

There are definitely things that eat into that potential, and they can be dealt with.

• Not enough sleep
• Snoring that disrupts deep sleep
• Picky eating and skipped meals
• Lack of exercise
• Health conditions that get in the way of growth

Growth care means finding and removing these so that a child at least grows as much as they naturally can. No more and no less.

Not all small children are the same

But there's something to do before that: figure out which group your child is in right now.

One: late growers

They're small, but they grow steadily along their own track on the growth chart. Often someone in the family was also a late grower.

In this case, we work on the factors that eat into growth while keeping track on the chart and watching.

Two: children held back by an illness

Their percentile on the growth chart keeps dropping. How fast they grow in a year falls short of the standard for their age.

In this case, tests come before treatment. Thyroid and growth hormone need to be checked.

Three: children growing too fast

They're bigger than their peers, but signs of puberty appear early. Changes such as breast buds show up early.

In this case, you need to look at bone age, not at how tall they are now.

The last two in particular have a time limit

The three groups are completely different paths.

Looking for something that will "make them grow" without making this distinction gets the order backwards.

And the last two are hard to reverse if you miss the timing. If the growth plates close early, the height that was still to come is lost, and that can't be undone later.

That's why the first step in growth care isn't a prescription but sorting out which group your child is in.

What does herbal medicine do?

On this point, we think it's most honest to give you the numbers.

There's a Korean clinical trial in children whose height was in the bottom 25%. It's a well-designed study. Children who took a mixture of herbal ingredients grew an average of 0.29 cm more than with the placebo over 6 months.

An effect was confirmed, but it's not a big number.

So we use herbal medicine not as a "medicine that makes you taller," but as a tool for dealing with the factors that eat into growth, such as sleep and digestion.

Wherever you hear a promise of a much bigger effect than this, you should ask for the evidence.

Sleep can't be skipped

Growth hormone is released mostly during the deep sleep of the first few hours after falling asleep.

That's why sleep is an item that can't be skipped in a growth consultation. We always ask what time your child goes to bed, whether they snore and whether they wake up during the night.

Even if you think your child "sleeps well," it's sometimes worth taking another look. If they keep moving around in bed, wake up with their hair soaked with sweat, or kick off the covers, they may look asleep while their body isn't resting.

Here's what happens when you visit us

We start with a growth chart. We measure height and weight and use past checkup records to trace their path on the chart. We calculate the expected range from the parents' heights and look at it together with you.

We check bone age. We look at bone age with a hand X-ray in partnership with the radiology clinic on the 2nd floor of the same building, and judge how much growing room is left from the gap with actual age.

We use tests to find factors that eat into growth. A blood test checks anemia and nutrition markers, and a body composition test shows what body weight is made up of. We also look at snoring, sleep quality, eating habits and digestion.

We measure every week and judge by the trend. Once a week, at about the same time, we measure and add it to the chart. The point of weekly measurements isn't a weekly report card but building a trend line. We judge not by one measurement but by the growth rate over several months.

If the growth rate falls short of the standard, we don't repeat the same care. We go back to sorting out which group your child is in.

We tell you what to expect in numbers. We only tell you as much as research has confirmed. We don't inflate it.

Come in when

• Your child's percentile on the growth chart keeps dropping
• How fast they grow in a year is clearly slow
• Signs of puberty such as breast buds appear early
• Your child snores or often wakes during the night
• You've been advised to start growth hormone injections but can't decide

If there are no particular warning signs, checking the growth chart and bone age once around the early years of elementary school gives you a baseline for later decisions.

One last thing

Whether to have growth hormone treatment is a matter for pediatric endocrinology. We don't make that decision in their place.

What we can offer is the basic information needed for that decision, and care for the foundation of sleep, nutrition and digestion that's needed whichever treatment you choose.

Growth rate and final height differ for each child depending on genetics, the timing of puberty, any other illnesses and daily life, and there is no treatment anywhere that can guarantee a particular height.