How Pediatric Growth Hormone Deficiency Is Treated

Pediatric growth hormone deficiency is a condition in which a child’s pituitary gland does not make enough of the hormone that is responsible for growth. Human growth hormone helps a child’s body grow and mature. When there is a deficiency of this hormone, a child can have symptoms that include a short stature, chubby build, younger-looking face, and late or absent puberty. 

Treatment for pediatric growth hormone deficiency involves replacing growth hormone in the body with injections. The treatment may be administered daily or several times per week. Serious side effects to these injections are rare, but some possible ones include headaches, fluid retention, body aches, and hip pain. With early diagnosis and treatment, many children with growth hormone deficiency are able to reach their full potential adult height. 

Specialist-Driven Procedures 

Treatment for pediatric growth hormone deficiency is long term and may take years to work. You will keep in close contact with your child’s pediatrician and pediatric endocrinologist to monitor your child’s growth and evaluate if the treatment is working. The only approved treatment for growth hormone deficiency is growth hormone injections. 

Growth Hormone Injections

The goal of treating children with recombinant human growth hormone (rHGH) injections is to replace the missing growth hormone to aid in growth, maturation, and metabolism. These injections are usually administered daily at home. Your medical team will work with you and your child and teach you how to administer the treatment. 

Your child’s starting dose will be determined by their pediatric endocrinologist. Your healthcare provider will aim to find the lowest dose possible that causes an improvement in your child’s growth rate and height. Starting doses usually range between 25 μg/kg/day and 43 µg/kg/day. The dose will also depend on how severe your child’s growth hormone deficiency is. Some children experience a low level of growth hormone produced by the pituitary gland while others are unable to produce any. 

Once your child begins rHGH injections, your healthcare provider will adjust the dose as needed. If your child is tolerating the injections well without side effects, your healthcare provider may recommend increasing the dose to achieve a faster growth rate and taller final height. This is usually evaluated every 6 to 12 months during treatment.

Throughout treatment, your healthcare provider may also monitor your child’s level of insulin-like growth factor-I (IGF-I). Growth hormone stimulates our bodies to make IGF-I, so if this factor is increasing, that means your child’s body is responding to the growth hormone injections. A low IGF-I level during treatment may mean that your child has another undiagnosed underlying condition that is causing the hormone deficiency. It could also mean that your child is not receiving all of their injections as prescribed. 

If the treatment does not result in increased growth and height, your medical team may run further tests to learn why that’s the case. After 6 to 12 months of no or very little improvement, the growth hormone injections will most likely be stopped. 

Administration

Giving your child daily injections is no small task. Fortunately, the injection is subcutaneous, which means that it is injected into the fat just below the surface of the skin. Only a short, small needle is needed, which hopefully causes less pain for your child.

Older children and adolescents may want to be responsible for their own injections. Because medication adherence is so important for effective treatment, they will most likely need daily reminders and supervision.

Growth hormone injections usually come in the form of a pen containing a shallow needle. It’s best to administer the treatment before bedtime because our bodies naturally produce growth hormone while we sleep.

If your child misses a dose, do not make it up. Missing more than one dose per month could decrease the treatment’s effectiveness. If your child will be away at a sleepover for the night, it is appropriate to shift the dose earlier by an hour or two. Injections of rHGH need to be kept refrigerated at 36 to 42 F. If they become too hot or too cold, they could lose their efficacy. 

There are eight injection sites possible for subcutaneous injections. The sites include the backs of the arms, outsides of the thighs, sides of the belly, or outer quadrants of the buttocks. It’s best to rotate sites to prevent irritation and bruising. Keep a log of injection times and administration sites with your child. 

Side Effects 

Side effects of rHGH injections are rare but may occur. The most common side effects are pain, swelling, and redness at the injection site. This can usually be prevented by rotating injection sites regularly.

Other more serious side effects to be aware of include:

• Fever 
• Insulin resistance
• Intracranial hypertension
• Prepubertal gynecomastia
• Slipped capital femoral epiphysis (SCFE)
• Scoliosis progression

If you believe that your child is experiencing side effects of the treatment, call your pediatrician or pediatric endocrinologist right away. Your healthcare provider may recommend lowering the dose or stopping the injections.

Prognosis 

The earlier growth hormone injections are implemented, the greater the likelihood that your child will reach their full adult height. While hormone injections do not work for every child, many experience significant growth during treatment. If the treatment is successful, parents can expect to see their child grow 4 or more inches in the first year and 3 or more inches in the next two years. Your child’s growth rate will then slowly decrease over time.

Prescriptions

While there are no approved prescriptions to treat pediatric growth hormone deficiency at this time, there is one under investigation. Several pharmaceutical companies are developing long-acting growth hormone compounds. This treatment could be given less frequently than daily rHGH injections.

Long-acting growth hormones can be administered weekly, biweekly, or even monthly. This could improve patient outcomes by making the treatment more convenient and consistent. Long-term efficacy and safety are still being studied. 

Talk with your healthcare provider about any new treatment developments or the opportunity to have your child participate in a clinical trial.

A Word From Verywell

Treatment for pediatric growth hormone deficiency is long term and often takes several years to complete. Daily injections of rHGH are usually effective at increasing your child’s growth rate and adult height. It may be helpful to remember that it takes time to find your child’s correct dosage.

Side effects are rare, but the most common ones include pain and redness at the injection sites. Because daily injections can take a toll on both you and your child, consider seeking help from a support group or mental health provider. These resources may help both of you cope with and feel understood throughout this long process.