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Pros And Cons Of Growth Hormone

Dear Dr Roach: I am very concerned about my grandchild’s growth — or lack thereof. She is 6 years old and has not grown at all this past year. She is 42 inches tall and weighs 40 pounds. She is the smallest child in her first-grade class. When they have family activities, some of the 3- and 4-year-old siblings of her classmates are taller than she. This doesn’t seem to concern her parents, and her mom is an RN. Am I overreacting? — J.L.

Answer: Not growing in a year is not normal. If that’s true, her pediatrician should be looking for any conditions (there are many) that can cause a child to stop growing.

In days past, if a child didn’t have a reason to not be growing or was growing at a slower rate than normal, we were unable to do anything about it. However, now that human growth hormone (HGH) is available for children who are short, parents have a choice of whether to use this medication to make their children taller. The medication is FDA-approved for children in the shortest 1 percent of their age and in absence of other diseases. Your granddaughter is right around that level.

The question is, Will treatment with this medication make her happier or healthier? There certainly are costs — it is expensive, requires prolonged treatment and can rarely have side effects. Although on average, a girl can expect about 2 inches of extra height after a full course of treatment, it’s not clear that this makes everyone happier. If being shorter than others isn’t bothering her or her parents, then I wouldn’t recommend treatment with growth hormone. I think there are appropriate times to use this medication, but the decision isn’t easy, and should be made considering both risks and benefits.

Dear Dr. Roach: I question whether a 75-year-old woman with atrial fibrillation and a stroke last year should drink any alcoholic beverages. What about moderate alcohol use? — J.E.

Answer: Atrial fibrillation is an abnormal, chaotic rhythm of the atria, the top chambers of the heart. Atrial fibrillation is a problem for several reasons, especially as it predisposes one to stroke. Because the atria don’t contract normally, blood clots tend to form inside the heart, and without treatment, about 5 percent of people with atrial fibrillation will have a stroke per year. Treatment, most commonly with warfarin as an anticoagulant, reduces the stroke risk to about 1.4 percent per year.

Frequent heavy use of alcohol is probably, but not definitely, a risk for atrial fibrillation. Acute intoxication with alcohol is a risk for atrial fibrillation. People who drink alcohol excessively also have difficulty with anticoagulation, because of both associated diet abnormalities and walcohol’s direct toxic effect on the bone marrow.

For all of these reasons, excess alcohol certainly should be avoided in anyone with atrial fibrillation. Since you ask specifically about moderate alcohol, I would recommend no more than one alcoholic drink per day. Remember that a 12 ounce glass of beer, a 5-ounce glass of wine, and a 1-1/2-ounce hard alcohol drink all contain roughly the same amount of alcohol, and all are considered one drink.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or write to P.O. Box 536475, Orlando, FL 32853-6475.