PATIENT WEBCAST
From the moment your baby was conceived, a growth process began that will continue
throughout his or her life.
As you look around at your family, friends, and the general population, you can see that
there is a wide range of what is considered ‘normal’ as it relates to height and weight.
Some children are smaller than others, and if your child falls into this category,
this does not necessarily indicate that your child has a growth problem.
However, poor growth in your infant or child may be a sign that a problem exists.
If you suspect that your child is NOT growing well, you should visit your pediatrician or
family physician and discuss your concerns.
Hi, my name is Dr Barbara Fivush. I am a pediatric nephrologist at the Johns Hopkins
Children’s Center in Baltimore, MD.
A pediatric nephrologist is a physician who treats kidney insufficiency or kidney disease
in children and young adults.
I often deal with growth issues because chronic kidney disease is one of the causes of
poor growth in children.
If you already know that your child has a kidney problem, it is very important that his or
her growth be monitored. In some cases however, small stature may also be the first
indication of kidney disease.
My child isn’t growing well, what should I do?
If you suspect that your child is not growing, the first thing you should do is talk to your
child’s doctor who will be able to determine if your child’s size or growth curve is a
cause for concern.
Your doctor or nurse will measure your child’s height and weight over a period of
6-12 months to evaluate the current growth rate.
These measurements will be plotted on a growth chart. Growth charts are simple grids
that allow you to plot your child’s height according to his or her age.
Children under 3 years old are usually measured every 6 months, while children over 3,
every year.
If there is a concern about growth, measurements may be taken as often as every 3
months to clearly determine your child’s growth pattern.
Your pediatrician may ask other questions, in addition to measuring height and weight,
such as:
What are your child’s eating habits? How is his or her appetite? Are there any past
illnesses or injuries?
The doctor may also ask about the health history of family members or about the birth
mother’s pregnancy, labor and delivery.
If your physician suspects kidney involvement, he or she may ask for other laboratory
tests that include hematology, blood chemistry, urinalysis, and assessment of kidney
function.
What do the kidneys do?
Your kidneys are bean-shaped organs, each about the size of your fist,
located near the middle of your back, just below the rib cage.
The kidneys clean out the waste and extra water from your body.
They also release hormones that help make red blood cells, control blood pressure,
keep the body’s chemicals in balance, and regulate growth.
Chronic kidney disease, also known as CKD, results in a progressive loss of kidney
function.
When someone has CKD, the body is affected in many ways.
In children, one of those ways is growth failure.
How do the kidneys affect growth?
When a child’s kidneys don’t function properly, the child may have difficulty reaching
normal height and weight because of the build-up of toxins in the blood, poor nutrition,
bone disease, anemia, and ineffective action of the body’s own growth hormone.
Growth Hormone is normally made in the body and is an important hormone that makes
your child grow. It plays a role in how the body processes food and how fast and how
well bones grow.
Most children with chronic kidney disease have normal levels of growth hormone - their
bodies sometimes don’t process the growth hormone effectively.
In the past, most children with CKD grew up to be much shorter than other children.
Today, we know that many of these children can be helped by manufactured growth
hormone.
When given, growth hormone can stimulate growth.
Why is early diagnosis and intervention important?
Since the early years of life see the greatest growth in all children, if your child is
diagnosed with chronic kidney disease, it is important to have discussions about
treatment options with your pediatrician or nephrologist early on.
The comparative difference in height seen in children with and without CKD appears to
be greatest for younger patients and the risk for growth failure is higher in patients who
develop CKD at birth or in early infancy.
If your child is “falling off the growth curve”, it should be addressed as soon as possible,
because an appropriate diet, medications and growth hormone therapy can have a
dramatic impact on your child’s ultimate height.
As a pediatric nephrologist, I urge parents to consider options that will help your child
reach his or her growth potential.
What else is important to consider?
Nutrition and medications play a vital role in the treatment of the child with CKD.
Some children with CKD experience changes in their appetite, which can be a real
challenge for families. Working with a nutritionist is very important.
Also, some medications may help slow the progression of CKD.
Treatment of conditions which occur in CKD, such as anemia and bone disease must be
addressed to ensure good growth.
If a kidney transplant is being considered for the future, it is important to optimize growth
before transplantation, because, while children may “catch up” after transplant, some
medications taken after transplantation can interfere with growth.
How is Growth Hormone administered? Is it safe?
Growth hormone is given by injection, usually daily.
It is not difficult to learn to do this and most kids and families get used to it quickly.
The dose is adjusted over time as your child grows or enters puberty.
Like any medication, a small number of patients treated with GH may have an allergic or
other reaction.
If growth hormone is considered, it is important that your child’s healthcare team do
periodic tests for renal bone disease, which can weaken bones and further interfere with
your child’s growth. If you have any questions about Growth Hormone therapy, such as
how it is administered, and what the side effects may be, it is important that this be
discussed, along with diet, exercise, and other medications.
Raising happy, well-adjusted children is a challenge under the best of circumstances.
For a child with CKD, there are many challenges that the child and his or her family may
be dealing with: dialysis, adequate nutrition, numerous medical appointments, sick days,
and time away from friends and school are some of the issues you will face.
Parents and healthcare providers should not overlook the importance of a child’s physical
growth and its potential impact on social development. Reaching his or her full potential
in height can make a lasting difference in your child’s self-esteem as they cope with
chronic kidney disease.
Every child is unique and each child deserves the chance to get the most out of life.
Please involve your health care team if you suspect that your child is not growing.
Monitoring your child’s growth can help them reach a greater adult height, will promote
health and self - esteem and may have a lasting effect on overall wellbeing.
If you would like more information about CKD related growth failure or available
treatments, contact the Kidney & Urology Foundation of America: 800.633.6628 or email
info@kidneyurology.org.