It is a very tricky question indeed. As a parent, it is very difficult to accept the fact that your child is not normal and requires growth hormone injections for kids. The trauma that a parent has to undergo thinking about this inevitable and most needed treatment is beyond imagination and we understand that. However, parents need to be practical and accept the fact that their child needs injections because of certain deficiencies, which the child may have.
When the child needs it, is still open for debate. It is always better to remember that being of short stature does not necessarily mean that the child is having a disease. The reason for short stature could be an underlying disease or a deficiency which need to be thoroughly checked, diagnosed and treated. The diagnosis can also be a challenging and daunting task. The treatment decisions can also be somewhat controversial in some cases. Everything boils down to one issue. Whether ethically, socially and medically, the decision to go for treatment with growth hormone injections for kids is correct or not has to be decided on a case to case basis. The other important factor to be considered is the side effects and unknown risks.
Is there a clinically written guideline which helps in deciding on when to start treatment for managing adolescents and children with symptoms of stunted growth? Yes, there is. Pediatric Endocrine Society, through some of its group of medical experts, has brought out a guideline on this issue. It specifically tells that treatment is recommended only for those children who have been clearly diagnosed with such medical conditions. In all other cases when the cause of such a symptom of stunted growth is not exactly and clearly diagnosed, the guideline specifies non-usage of growth hormone treatment. These cases require a measured and practical approach.
Coming to the diagnosis, the medical experts, have brought out three major diagnosis approach.
- Growth Hormone Deficiency
- Idiopathic Short Stature (ISS)
- Primary IGF-I Deficiency (PIGFD)
Growth Hormone Deficiency (GHD)
In this case, the deficiency stems from the fact that enough growth hormones are not produced in the child. This requires a standard treatment coupled with growth hormone which would enable the production of enough growth hormone in the body. These hormones act as an impetus for stimulating another important factor which is an IGF-I growth factor. This factor is required for growth of body tissues in the bones which would help in the overall growth. With this direct link between the two, any growth hormone deficiency will result in the deficiency of IDF-I in the body.
Primary IGF-I Deficiency (PIGFD)
The reason for this deficiency to occur is due to a biological defect which results in the reduction of the production of IGF-I growth factor. It is necessary to know that in these cases, the patient or the child has enough growth hormones except for the biological defect. It is pertinent to note that this biological defect occurs due to undernutrition which is a common cause. Hence, the diagnosis shall cover the problems of adequate nutrition before diagnosing the deficiency due to low IGF-I level. A child with PIGFD shall be treated with a recombinant IGF-I growth factor.
Idiopathic Short Stature (ISS)
The reason for causing short stature is still not known. In these cases, it is necessary for the parents and doctors to approach and treat the problem through mutual decision making. By this, we mean, the decision should consider various factors like psychological and physical effects on the child including the probable benefits and risks.
Can we really rely on the tests conducted to assess the deficiency?
For this, the answer is both yes or no. Yes, because, sufficient research has been made in the field and more or less, the tests are yielding the required result. No, because, even now, it is told that there are research gaps which exist in diagnosing the growth hormone deficiency. Such being the case, is it necessary to give Growth Hormone Injections for kids? The answer lies in the approach of a parent towards the stunted growth in their child. No parent wishes to see that his/her child is not growing up to his potential. Hence, it often requires a pragmatic approach from the parent in consultation with Pediatricians to take a decision on administering growth Injections to their child.
In conclusion, we can say that there are also some ethical questions which need to be answered. These are in addition to the medical questions which generally arise in such patients. However, it is necessary for the pediatric endocrinologists to weigh the pros and cons of administering such growth hormones and also considering the risks and benefits associated with it. This should be on a patient to patient basis and not on a general term.