NEW YORK — Significant growth slowdown during treatment with stimulants may occur in a small subset of children who require closer monitoring and referral, Dr. Harold E. Carlson said at a psychopharmacology update sponsored by the American Academy of Child and Adolescent Psychiatry.
Height velocity, or yearly growth, typically slows for the first few years of stimulant therapy and then resumes at a nearly normal rate, said Dr. Carlson, head of endocrinology at the State University of New York at Stony Brook.
Final adult height is usually normal with long-term use of stimulants. However, a small subset of patients, perhaps 10%, have a more significant slowdown of growth, Dr. Carlson said.
“I don't think anybody has a good handle on how many [children experience this significant slowdown], and we certainly don't have a good idea as to how to identify them ahead of time,” he said.
Because the secretion of growth hormone in these children is normal, researchers have speculated that the slowdown may be related to a decrease in food intake while on stimulants. “That's probably it,” Dr. Carlson suggested, because “people on stimulants, especially on higher doses, often lose their appetite.”
The slowdown of growth is greater in prepubertal children, boys, children who are taller or overweight, and children who use sustained-release formulations.
Dr. Carlson advised obtaining prior growth records and measuring the height and weight of children before beginning stimulants. Height and weight should be measured and plotted every 6 months while on treatment. A decrease of more than one standard deviation in height for age while on treatment should prompt consultation to exclude other disorders.