Some growth disorders and impairments can be seen at birth, while others are noticed when your child fails to keep pace with other children their age with regards to growth. Social Security distinguishes between height and weight when assessing growth impairments for disability benefits. Short heights are evaluated under the growth impairment listing, while weight deficiencies are assessed under other listings.
Causes of Growth Impairments
There are several different disorders and ailments that can cause short heights. Some of those impairments include:
- Human Growth Hormone (rhGH) Deficiency, which causes a noticeable slowing of growth. Hormone replacement therapies can often help a child to reach an average adult height.
- Cushing's Syndrome, which is caused by too much cortisol in the body and is characterized by weight gain without changes in height. This syndrome can also lead to weakening of the bones and overall weakness throughout the body.
- Hypothyroidism, which is caused by an underactive thyroid gland (which controls hormones in the body).
- Nutritional Short Stature, which is caused by improper nutrition that prevents the body from developing properly. Malnutrition can also lead to bone weakness and wasting. This can be reversed through proper nutrition.
- Fetal Alcohol Syndrome, which is caused by drinking during pregnancy and can cause short stature.
- Intrauterine Growth Retardation ("IUGR"), which occurs in the womb and causes an overall short stature.
- Russell Silver Syndrome, which usually begins in the womb and causes additional symptoms beyond short height, including hypoglycemia and kidney malformation.
- Disproportionate Short Stature (commonly referred to as dwarfism), which is caused by impaired growth of the bones and cartilage in the body.
- Achondroplasia, which is the most common of growth impairments, and is characterized by specific physical features.
- Diseases of the heart, lungs, and kidneys, which may prevent the body from absorbing the proper nutrition and thus lead to short stature.
- Diabetes, which may cause slow growth, especially in children whose blood sugar levels are not properly controlled.
- Bone disorders, including bone dysplasia.
Qualifying for Social Security Disability Benefits
Children can be eligible for Social Security disability benefits under the Supplemental Security Income (SSI) program. In order to qualify for these benefits, your child must meet both technical and medical requirements.
- Technical requirements: The household in which the child lives must meet certain income and asset requirements.
- Medical requirements: The child must meet or "equal" a listing in the Social Security “Blue Book” for growth impairments or must "functionally equal" the listings.
If your child was low weight and length at birth, see our article on getting disability for low birth weight.
Meeting a Listing
Growth impairments are covered under the Social Security Blue Book for children, which covers impairments that are predetermined to be disabling for children. To meet the requirements of listing, you must meet one of the following sets of requirements.
- A growth impairment related to a specific medically determinable cause (see above list for examples) with:
- a decrease in height greater than 15% that remains unchanged; or
- a decrease in height, or height that remains, below the third percentile on growth charts.
- A growth impairment from an unknown cause with:
- a decrease in height greater than 25% that remains unchanged; and
- a bone age that is greater than two standard deviations below their actual age.
Having a medically determinable impairment means there must be evidence of an active disease process that's causing the growth impairment A disease process for those with a growth impairment is shown by a number of height measurements over time that show your child is growing at a less than expected rate. However, if your doctor hasn't been able to identify a disease process that's causing the growth impairment, your child can still qualify for benefits, under the second set of requirements above.
Short height in and of itself is not enough for a child to be disabled. Because a child is short does not mean that there is a medically determinable impairment. Some of the growth impairments that are not by themselves disabilities include:
- Short height, even if it is below the third percentile.
- Constitutional Growth Delay (CGD), which is a delay in growth that varies from the normal growth of children of the same age. CGD usually begins during infancy and is characterized by a decrease in growth trajectory. However, normal growth is generally achieved by the time the child reaches two years old.
- Familial Short Stature (FSS), which occurs when a child’s height is below the third percentile and the child comes from a family with relatives who are short.
Medical Evidence Required
To prove a growth impairment, you will need to provide at least three measurements of your child over time to show their lack of growth, including length at birth if possible. If you don't have several measurements at the time you apply, Social Security will hold your application until more measurements can be obtained. In addition to your child’s weight and height measurements, you must also submit that of your child’s natural parents and the age and heights of all siblings.
To prove bone age, medical imaging should be provided, which can include x-ray imaging, CAT scan or MRI, myelography, and radionuclear bone scans. Medical evidence should include a scan of your child’s left hand and wrist. For children who have past puberty and growth has stopped, medical imaging of their knee and ankle should also be provided.
Functionally Equal the Listings
If your child does not meet the listing for growth impairments, your child may be able to “functionally equal the listings” if they have significant functional impairments. To “functionally equal the listings,” your child must have impairments that can be considered equal in severity to the listings in the Blue Book. There are six functional domains that Social Security assesses in determining this functional equivalency, including movement, self-care, and health and physical well-being. Your child must have two “marked” limitations or one “extreme” limitation within the six functional domains.
Those children with growth impairments may have physical difficulties due to their short height with regards to movement and self-care, especially if your child has shorter arms as a part of their growth impairment. Examples of difficulties may include difficulty climbing stairs or dressing themselves due to physical limitations. However, it is fairly rare for a child to functionally equal the listings for growth impairment. For more information, see our article on functionally equaling the listings.
Continuing Disability Review (CDR)
If your child is approved for benefits, Social Security will periodically review your child's medical records to insure that he or she is still disabled. For children with disabilities that have the possibility of improving, such as growth impairments, they may be reassessed every three years, or even more frequently. For more information, see our series of articles on continuing disability reviews.