What are the factors that retard growth?
There are several. To start with, genes are 50 per cent responsible for growth. But there are other factors to consider too. In Japan, after the World War II, children achieved six inches in just one generation. And the reason for this was a protein-rich diet and fewer chronic infections.

In India, however, we have gained just five inches in the last 50 years. What slows down growth in children here is chronic infections. Worm infestations, tonsillitis, or abdominal infections impede the production of Growth Hormones (GH).

Another important factor is emotional stress. When I was attached to the Great Ormon Street Children's Hospital in London, we conducted a study that revealed this. Hundred children, all short-statured for their age, were part of the study.

After conducting tests, we found that all of them had stopped producing the GH and that they were being sexually or physically abused. Once removed from their abusive environment, they once again began production of the GH within two or three months.

The child's growth is affected by stress and chaotic family surroundings. Overly strict parents can cause emotional stress and that stops the production of the GH. Expectations that go well beyond the child's ability or ridiculing him/her can also put a strain on the child and slow or stop the GH production.

What is the situation like in India?
Hypothyroidism in infants is totally neglected. I find that appalling. Hypothyroidism leads to mental retardation in children, but ironically enough, it is the only treatable cause of retardation. If untreated within the first six weeks of a child's birth, it can lead to a loss of 10 IQ points for every week after that. Testing for hypothyroidism should be made mandatory.

Precocious puberty amongst girls has become fairly common. In 1960, the average age for girls attaining puberty was 14.5 years. But now, it is not unusual for a 10-year-old girl to be menstruating. There is nothing wrong with this, except that the production of estrogen slows down the production of GH. So growth after menstruation is only approximately 2 or 3 inches. There is also psychological immaturity to consider. In some rare cases, one does come across a four-and-a-half-year-old girl who menstruates.

How do you deal with a girl-child who menstruates early?
The safest way to postpone menstruation in young girls who are in the pre-menarche period is through exercise. Exercise is known to delay menstruation, as is common amongst ballerinas or overly-athletic girls, whose periods stop temporarily while they exercise. If a girl menstruates at the age of 10 or so, there is not much we can do. But if a child of seven or eight begins menstruation, we treat her with hormones that are completely safe.

With these hormones, their uterus mimics that of a girl who has not started her periods. Till the normal height is achieved, she will continue on this medication.

It is believed that hormones used to treat short-statured children can pose a health risk later...
Prior to 1985, hormones taken from cadavers were used to treat short-statured people. That caused a neurological disease called the Cruzfield Jacob Disease, the equivalent of the Mad Cow Disease where the brain deteriorates rapidly. So this steroid was withdrawn.

A new steroid was developed in its place. It is being given to 40,000 kids all over the world. So far, since 1985, not a single side-effect has been reported.

What is the effect of physical growth on mental development?
Apart from thyroxin, no other hormone works directly towards brain growth. But there are psychological factors that come into play when physical growth is abnormal. A short-statured child will feel that he/she is different from normal children and this feeling of inferiority can hamper performance at school.

How can you predict the final height of a child?
By taking an X-ray of the hand and the wrist. By looking at 13 different bones, we can obtain a fairly accurate bone age. Based on this, the actual height and the speed of growth, we can predict what the child's final or adult height will be.