Expert Answers: My five-year-old son hates injections

There are many different causes of too little or too much growth in children but most, with the right medical intervention, can be helped.

Very slow or very fast growth can sometimes signal a gland problem or disease and this should be investigated, although some growth disorders start in the womb.

Growth Hormone Deficiency (GHD) is generally due to the pituitary gland being unable to produce sufficient GH to generate the growth process. GHD does not affect intrauterine growth (a condition where a baby's growth slows or ceases when it is in the uterus), at least to an extent measurable by birth weight or length, but from the second year of life growth is slower than normal and occasionally growth failure commences from birth. Most cases of growth hormone deficiency are idiopathic, meaning of unknown origin. Idiopathic growth hormone deficiency occurs, it seems, in about 1 in 3,800 births.

GHD may also be hereditary, at least in some cases. About 3 per cent of children with GHD have brothers or sisters who also have the disorder. In a very few families one of the parents is affected. The deficiency is two to three times more common in boys than in girls, for reasons quite unknown

Children with GHD are small with normal skeletal proportions, facial appearance and intelligence. They tend to be overweight (this reduces during GH treatment) and they often have a delayed bone age. The diagnosis is confirmed by measuring the level of growth hormone production in response to a stimulation test which normally requires a morning in hospital.

The Child Growth Foundation (CGF) was formed from an initiative of the Institute of Child Health in London which brought together a group of parents some 30 years ago.

The website carries a large number of personal stories that can be very encouraging for parents whose children are newly diagnosed.

Parents are helped by the CGF to obtain a faster diagnosis; to then understand the implications and possible treatments and also gain support from other parents.

n Contact information: www.childgrowthfoundation. org has a number of leaflets and a range of information to help understand the various conditions.

The helpline number to call is 0208 995 0257 or 0208 994. It is open Monday to Friday from 9am- 4pm.

Paul Charlson

GP from Brough

This is obviously very distressing, However at least your son has been diagnosed and there is a recognised effective treatment for the condition. There are plenty of websites which explain the condition. The Child Growth Foundation is a charity which can give you support and information on [email protected] and this might be a good place to start.

Medical websites will give you all the information you need but to get it into context it is always better to talk to other parents who have children with the problem. Either the charity or your child's consultant will be able to help put you in touch with others.

In regard to the injections, I think you should let the professionals guide you through the administering of the daily injections your child needs. In time it will become second nature to you all. I find EMLA cream helps take the sting out of injections and your GP can provide this.

Fiona Caine

Agony Aunt

Growth hormone deficiency is not as uncommon as you might imagine.

In years past, dwarfism might have occurred but, thanks to modern medical treatment, this is increasingly unlikely.

Yes, your son almost certainly will have to have regular, probably daily, injections and yes, it's not pleasant.

However, I suspect you'll find he will adjust to it faster than you expect.

If you go to the website of the Child Growth Foundation (www.childgrowthfoundation.org) you will be able to read stories from children and young people on how they've learned to adjust.

I think you will find it reassuring.

I would also recommend you consider joining the foundation as it should be able to provide you with all the advice, information and support you need.

Cary Cooper

Professor of Organisational Psychology and Health at Lancaster University

Let me start by saying I know very little about these conditions but your concern is that you don't have enough information about the condition or what the implications of the treatment are. If it was my son, I would do two things; first, I would attempt to Google to get as much information about it online from a reputable source and to find out if there is a growth hormone deficiency support group in your area.

If there is such a group near you, I would try to obtain all the answers to your questions from people who have experience of it. Then I would make an appointment with the consultant, this time armed with all the questions (written down ahead of time) that you want answered, informed now by the information you have obtained online and from the support group.

Dr Carol Burniston

Consultant Clinical Child Psychologist

In the early days of receiving this kind of news, one feels shocked and afraid because we don't understand the implications. We can only take in a limited amount of the information we are given and the people who are caring for your son will appreciate this.

Ask all the questions you like, by telephone, by letter or at the next appointment. Most special clinics for children have liaison nurses who can spend more time with you to help you to understand your son's condition and explain it to him in a way he can understand. Ask to see them at your next visit.

Lots of children have medical conditions which require regular injections, most of them adjust over a period to this. If your son finds it difficult in the medium term, he can be referred to a children's mental health professional such as a child psychologist who can help with adjustment issues and behavioural approaches if necessary.

The treatment which seems cruel to you now will help your son's growth in the long term and enable him to live a life where he feels that he is a similar size to everyone else.