Some people with restricted growth (dwarfism) have health problems. But for many, the only sign is short height.

Proportionate short stature

People with proportionate short stature (PSS) grow very slowly and have a general lack of growth throughout the body. The body, legs and arms are all shorter than normal.

PSS may not be noticeable until later in childhood or puberty.

Any other symptoms the person has will depend on the underlying cause of PSS.

Disproportionate short stature

In people with disproportionate short stature (DSS), the arms and legs are particularly short.

People with achondroplasia, one of the most common causes of DSS, typically have:

• a normal-length body with short arms and legs
• a large head with a prominent forehead and flat nasal bridge
• short and wide hands and feet
• short fingers and toes

Some people with achondroplasia also have:

• bowed legs, which may cause ankle or knee pain 
• an abnormally curved spine (kyphosis) or (scoliosis)
• a build-up of fluid around the brain (hydrocephalus)
• repeated ear infections, which can cause hearing difficulties
• irregular breathing at night (sleep apnoea), which can interrupt sleep and cause excessive sleepiness during the day
• numbness and weakness in the legs, caused by compression of the nerves in the spine

Some people with restricted growth (dwarfism) may be able to have growth hormone treatment or leg-lengthening surgery.

Growth hormone medication

The National Institute for Health and Care Excellence (NICE) recommends human growth hormone treatment (somatropin) as an option for children whose poor growth is linked to:

• growth hormone deficiency
• Turner syndrome
• Prader-Willi syndrome
• chronic kidney disease
• a genetic condition called SHOX deficiency

NICE also recommends it for some children who are born small and fail to catch up in growth by the age of 4 or later.

Somatropin treatment should be started and monitored by a child health specialist with expertise in managing growth hormone disorders in children (paediatric endocrinologist).

The hormone is given as a single daily injection, which can usually be done by a parent, carer, or by the child when they're old enough.

Skin reactions are the most commonly reported side effect. In very rare cases, the treatment is associated with persistent severe headaches, vomiting and vision problems.

Children with growth hormone deficiency respond very well to somatropin and may be able to reach a relatively normal adult height. The effectiveness in children with other conditions can vary.

Somatropin treatment may stop once your child stops growing, but in some cases it may be given into adulthood because it can sometimes help prevent problems such as weak bones (osteoporosis).

For more information, read the NICE guidelines about:

• Human growth hormone (somatropin) for the treatment of growth failure in children
• Human growth hormone (somatropin) in adults with growth hormone deficiency

Leg-lengthening surgery

If you have particularly short legs, a leg-lengthening process known as distraction may be an option.

Using surgery, the leg bone is broken and fixed to a special frame. With the support of the frame, the leg is stretched, allowing new bone to form in between the two broken ends of bone.

Over time, this bone gets stronger until it's able to support your weight.

Distraction can sometimes result in a significant increase in height, but it's a lengthy treatment and has a risk of complications, so isn't always recommended.

Some people have pain during or after the limb-lengthening procedure.

Other possible complications include:

• poor bone formation
• fracture
• infection
• bone lengthening at an inappropriate rate
• blood clots

There's also some uncertainty about the safety and effectiveness of the procedure.

It's therefore important that you understand exactly what it involves and talk to your surgeon or doctor about the risks if it's suggested as a possible treatment for you or your child.

For more information, read the NICE guidelines about:

• Intramedullary distraction for lower limb lengthening

Support and treatment for related problems

As restricted growth can be associated with several related conditions and problems, affected children and adults will be cared for by a multidisciplinary team of healthcare professionals.

This team may include:

• a paediatrician (child health specialist)
• a nurse specialist
• a physiotherapist
• an occupational therapist
• a dietitian
• an audiologist (hearing specialist)
• a speech and language therapist
• a neurologist (specialist in nervous system disorders)
• an orthopaedic surgeon
• a geneticist

You may have regular check-ups with members of your care team so your health can be monitored and any problems that develop can be treated.

Help and support

If you or your child has restricted growth and you'd like to speak to someone for advice and support, the Restricted Growth Association UK has a helpline you can call on 0300 111 1970.

The RGA website also has more information for parents.