How the child grows:

In order for a child to grow, a gland deep inside the brain, called the pituitary, must release enough growth hormone (GH). Natural growth hormone is released during deep sleep. Many factors influence the release of GH, including nutrition, sleep, exercise, stress, medications, blood sugar levels, and other hormones present in the body. When a child’s body does not produce or release enough GH, he or she may have several symptoms, the most noticeable being slow or no growth or facial features that make the child look a lot younger than his or her peers. Although being small has no effect on a child’s intelligence, it may cause self-esteem issues and interfere with the development of mature social skills.

How Growth Hormone Treatment Works

Once a child has been diagnosed with a condition requiring growth hormone, the doctor will discuss the pros and cons of GH therapy. The GH used in treatment is manufactured in the laboratory to be identical to that produced by the pituitary gland, so it is safe and effective. GH is given through an injection under the skin in the fat. GH can be given by a special injection device that looks like a pen. Because it is such a shallow injection, the needle is very small and does not hurt much at all.

What To Expect With Growth Hormone Treatment

The main thing to expect is growth! Although it takes about 3 to 6 months to realize any height differences. There may be a few other things you notice:

• Your child may outgrow his or her shoes quickly
• Your child may want to eat more. An increase in appetite is common, especially if he or she had a poor appetite before treatment.
• Your child may look skinnier for a while once height growth starts. An increase in lean body mass and decrease of fat mass are common with GH treatment.

It may take a number of years for your child to reach his or her adult height, so you should be aware that GH treatment is often a long-term commitment. Routine visits with your doctor will be needed, as will be monitoring height, weight, periodic blood tests and x-rays. Although the length of treatment varies, your child probably will have to stay on GH treatment until he or she has:

• Reached his or her full adult height
• Reached full bone maturity
• Grown less than 2 cm in the last year

Getting and Giving GH Injections

• GH injections are quick and almost pain-free, so children ages 10 and up may be able to and often prefer to give themselves their own injections.
• It is important that a parent supervises the injection to make sure the child gives the correct dosage each day. Parents should give the injections to younger children.
• Because natural growth hormone is released mainly during sleep in children, GH treatment is more effective when taken at bedtime. You may change the time occasionally, by a few hours earlier or later, but do not give before 5 p.m, except under unusual circumstances (such as leaving for a trip, a sleep-over, etc.)
• Learning how to give GH injections may sound intimidating at first, but once you and your child get used to it, it becomes just another daily habit.
• Do not make up missed injections.
• For best results, try not to miss more than once per month.

Storage

• GH must be refrigerated; letting it get too hot or too cold will decrease its effectiveness.
• If left out overnight, you may place it back into refrigerator and continue to use it.
• When traveling, keep it in the cooler provided in the starter kit for up to 10 hours, then put on ice after 10 hours. Be careful not to place GH pens directly in ice — keep them separate by placing pen in a Ziploc bag.

Injection Sites

• Use 4 of the 8 possible injection sites, and rotate them each time. The sites are back of arms, top or outside of thighs, sides of belly, and outer quadrant of buttocks.
• Document the site used nightly on a calendar.
• Document when you open a new cartridge to keep track of expiration dates and how many injections have been used out of each cartridge.

Finishing A Cartridge

• Because GH is very expensive, you should use up all of the medication in every cartridge.
• Pens will only allow you to dial to what is left of the medication. Use up the last of it, and start a new cartridge by doing a second injection with the amount missing.

Other Medications

• Since GH does not interfere with other medications, it can be taken even if your child is mildly ill (colds, flu), unless your PCP tells you to stop.
• If your child becomes seriously ill or is hospitalized, call the Endocrinology Clinic for further instructions.

Possible Side Effects

Although infrequent, there are some possible side effects that you should be aware of. They are:

• Allergic reaction, including swelling at the injection site, rash, or hives
• Hip, knee, or other joint pain
• Headache
• Progression of spine curvature in patients with scoliosis
• Temporary increase in blood sugar levels, which stops when the GH treatment stops

If the headache is persistent or severe, however, call the doctor immediately