Daniel Ganjian, MD, FAAP is a board certified pediatrician at Providence Saint John’s Health Center in Santa Monica, CA. He is also an Alpha Omega Alpha Honor Medical Society Member. The information shared here represents his expertise as a pediatrician with over 15 years experience.
Pediatric growth hormone deficiency (pGHD) doesn’t just affect your child’s height — it can cause a range of symptoms that affect their daily life, like fatigue, muscle weakness, and trouble sleeping. Over time, pGHD can also lead to more serious issues like heart disease and depression.
We asked Daniel Ganjian, MD, a pediatrician at Providence Saint John’s Health Center in Santa Monica, California, to explain this rare condition and how it can be successfully treated.
How do you explain pGHD to caregivers?
Think of pGHD simply as your child's body not making enough of a very important chemical called growth hormone. GH is produced by a tiny gland in the brain called the pituitary gland. It's not just about height; GH is like a master switch that helps children grow tall, but it also helps build strong bones and healthy muscles, and it regulates energy and metabolism.
Because your child is missing some of this crucial hormone, they grow much slower than other kids — this is the most common sign. We usually treat it because not having enough GH affects their health and development, not just their size.
What causes pGHD, and how often do you see it?
pGHD is rare, affecting only about 1 in 4,000 to 10,000 children, and it's most often idiopathic, meaning we don't know the exact cause. Sometimes it's due to birth trauma or a pituitary issue. The main telltale sign is a significantly slow growth rate — less than 2 inches a year after age 3.
What’s the typical treatment like?
The treatment for pGHD is straightforward: We simply replace the missing hormone. The typical treatment consists of a manufactured hormone that is identical to what the body should be making, given as an injection once daily, usually at bedtime.
We use a very small, thin needle in a pen-like device that makes the process quick and easy. We choose bedtime because it mimics the body's natural release of growth hormone, which happens during deep sleep.
Your child will continue this treatment until their growth plates close (usually in the mid-to-late teens) and they've reached their final adult height.
When does treatment typically start, and how do you get kids onboard with it?
We usually start treatment in the preschool or early elementary years (ages 4-8), which is when the slow growth becomes most obvious. To get kids on board, we focus on empowerment.
For young ones, it's their "helper medicine" that makes them big and strong.
For older kids, it’s about control: teaching them how to do the simple, quick daily injections at bedtime themselves.
Can you explain the importance of treating pGHD? What are the risks/complications if it’s left untreated?
The good news: This is a manageable condition with an excellent outlook.
First, let's address the big "why." Treating pGHD is absolutely crucial, and not just for height!
Growth hormone is a vital component for strong bones, healthy metabolism, and developing good muscle mass. If left untreated, your child faces risks far beyond short stature, including poor bone density and metabolic issues down the road. Plus, the psychosocial impact of being extremely short can be significant.
If parents want to take a "wait and see" approach, what's your response?
My gentle advice is to avoid it. The growth window is finite; once those growth plates close, they're closed for good.
Delaying means losing irreversible time for your child to reach their full potential height.
What challenges do parents face in treating their child?
The biggest challenge for parents is often injection fatigue — the grind of doing it every single night. My best advice is to make it a non-negotiable part of the routine, like brushing teeth. Involve them; let them pick the site.
Don't let the cost of medication worry you unduly; nearly every pharmaceutical company offers robust patient assistance programs that we can help you navigate.
On the safety front, side effects are usually minor — a little redness at the injection site, which can be managed by rotating where you inject. Severe complications are very rare. And please ignore the persistent myth that growth hormone causes cancer; it simply isn't true for children with typical pGHD.
What do you tell parents who are worried about treating pGHD?
I hear a lot of worry about the treatment itself, especially the idea of daily injections. I want to reassure you that we are simply replacing what is missing, not adding something foreign. The medication is bio-identical to the hormone your child's body isn't producing enough of. This treatment has been used safely for decades.
We are partners in this, and we’ll make sure you’re comfortable with the simple, pen-like devices before you leave the clinic.
What’s the outlook for kids with pGHD?
Ultimately, the outlook is fantastic. Early intervention is key to maximizing that finite growth window. I have personally treated children who started below the third percentile and finished treatment at the 50th, thanks to that incredible "catch-up growth" we often see in the first year. The results are wonderful, not just in height, but in watching these kids transform from shy, withdrawn children into confident, thriving teens.
You're giving your child a healthy, confident future, and that’s a beautiful thing. Just know that we are on this journey together.
Over the years that you’ve treated pGHD, have you grown more optimistic or confident about the treatment results?
I have grown incredibly optimistic and confident over the years regarding the treatment and its results. There are a few key reasons for this confidence:
Growth hormone therapy is one of the most studied long-term treatments in pediatric medicine. We now have decades of data showing it is safe and highly effective, which allows us to treat kids with far greater certainty than in the past.
The invention of modern, pen-like injection devices has made the process much easier for children and parents, leading to better adherence (doing the shot every day). When kids are consistent, the results are much better.
We consistently see children achieve remarkable "catch-up growth," often reaching a height well within their family's genetic potential. The physical and psychological transformation — seeing a child gain confidence along with height — is profoundly rewarding and validates the importance of starting treatment early.