Why our children aren't reaching their full height
How tall a child will grow depends about 80 per cent on the height of their parents. The remaining 20 per cent is influenced by congenital conditions and a range of environmental factors. However, even a child with the genetic potential to reach their parents' height may not do so because of various health and lifestyle factors.
How long do children continue growing?
Humans typically reach their full height through rapid growth during the first three years after birth and later during puberty. Girls can grow up to the age of 15, while boys can grow until 17. However, growth begins to slow considerably after around 13 years in girls and 15 years in boys.
From the age of three until the onset of puberty, children typically grow by an average of 5 centimetres (2 inches) per year. However, this pattern does not apply to every child.
Several medical conditions including certain genetic syndromes, skeletal disorders and metabolic diseases can result in short stature from birth.
Some congenital conditions, such as thyroid hormone deficiency, growth hormone deficiency, diabetes, Turner syndrome and kidney disease, may respond to hormone therapy, allowing affected children to achieve a more normal height.
Maternal health and proper nutrition during pregnancy also play a crucial role in determining a child's future growth. Babies born prematurely or with low birth weight who fail to catch up in height and weight by the age of three or four may benefit from growth hormone therapy. Taking these factors into account can help doctors estimate a child's expected adult height after birth.
The causes
According to the latest data, one of the leading causes of short stature among children in Bangladesh is stunting, a condition in which prolonged malnutrition prevents normal growth. Stunted children are also typically underweight.
Why does prolonged malnutrition occur? While poverty and limited access to nutritious food are major factors, several other causes also play significant roles:
Frequent illness: Children who fall sick repeatedly require more energy while often eating less. This combination creates a calorie deficit, causing weight loss or poor weight gain. Over time, inadequate calorie intake affects height growth. Children need proportionally more calories than adults to support normal growth, making a balanced diet rich in carbohydrates, proteins, and fats essential.
Poor appetite: In Bangladesh, parents often seek medical advice or vitamin supplements to improve a child's appetite. However, loss of appetite is a symptom, not a disease. There is no such thing as an ‘appetite specialist’. The underlying cause must first be identified. A healthy child should naturally feel hungry. Even when a child appears physically healthy, environmental and psychological factors may reduce appetite. Regular meal timing is also important, as the stomach needs time to empty before the next meal. Feeding a child too frequently or forcing them to eat can worsen the problem.
Chronic constipation: Numerous international studies have shown that long-term constipation, when a child does not pass stools regularly or completely, can reduce appetite. This can lead to prolonged malnutrition and impaired growth. Constipation often causes abdominal bloating, but simply giving medicines for ‘gas; without treating the underlying constipation is ineffective. Moreover, prolonged use of such medications may cause side effects.
Dietary habits have changed significantly. Many children now prefer processed or fast foods over balanced home-cooked meals such as rice, lentils, vegetables, fish and meat. These commercially prepared foods are often nutritionally poor, lacking essential vitamins and minerals while containing either too few or excessive calories. As a result, children may become undernourished or overweight. Such foods can also contribute to constipation, bloating and other digestive problems. Conversely, some parents try to boost growth by feeding excessive amounts of fruits, nuts or protein-rich foods, which is also not advisable.
A balanced diet is essential. Children's meals should include carbohydrates, proteins, fats, vitamins, minerals and adequate water. Ideally, 50–60 per cent of daily calories should come from carbohydrates, 15–20 per cent from protein and 25–35 per cent from fats. Vegetables should be included in every meal, as they are vital for preventing constipation and providing sufficient vitamins and minerals. Vitamin or mineral syrups alone cannot increase a child's weight or height. However, research suggests that long-term vitamin D deficiency may hinder overall growth and height development in children.
The way forward
If a child appears to be short-statured, they must be evaluated at an early age to determine the cause and receive necessary treatment. If a treatable cause for stunted growth is found, medical intervention should begin promptly. For children who are otherwise healthy, the following steps should be taken to ensure they reach their target height:
Infants should be exclusively breastfed for the first six months. Afterward, balanced complementary foods must be introduced, while avoiding outside or processed food as much as possible.
Keep a close watch on whether the child is gaining weight appropriately. If not, take immediate action. Being underweight is a sign of malnutrition and acts as a barrier to future growth.
Any illness must be treated quickly and completely.
If a child’s appetite decreases, do not rely on so-called appetite stimulants or ‘gas medicine.’ Identify the specific underlying cause and take appropriate measures.
Once a child reaches two years of age, they should be taught regular bowel habits or provided with proper toilet training.
Ensure the child is regularly exposed to sunlight to provide an adequate supply of Vitamin D.
The author is a Professor and Head of the Department of Pediatric Endocrinology at the Bangladesh Shishu Hospital and Institute, Sher-e-Bangla Nagar, Dhaka.