Do Selective Serotonin Reuptake Inhibitors (SSRIs) disrupt growth plate access and affect growth in children?

SSRIs and Growth in Children

SSRIs do not appear to significantly disrupt growth plate access or cause clinically significant growth impairment in most children, though isolated cases of growth attenuation have been reported.

Effects of SSRIs on Growth

• The American Academy of Child and Adolescent Psychiatry (AACAP) clinical practice guidelines do not list growth impairment as a major concern for SSRIs when used in children and adolescents 1
• The primary side effects of SSRIs documented in clinical guidelines include appetite changes, gastrointestinal symptoms, sleep disturbances, behavioral activation, and rarely more serious concerns like suicidal ideation 1
• While stimulant medications for ADHD have documented effects on growth velocity (typically 1-2 cm reduction), similar prominent warnings are not included in SSRI guidelines 1

Evidence for Growth Effects

• A small case study of 4 children (aged 11.6-13.7 years) treated with SSRIs for 6 months to 5 years showed growth attenuation, with 3 exhibiting decreased growth hormone response to stimulation tests 2
• In this limited study, 2 patients resumed normal growth after discontinuation of SSRI therapy, while 2 others required growth hormone treatment while continuing SSRIs 2
• This evidence is limited by the very small sample size and lack of controlled studies specifically examining this outcome 2

Mechanism Considerations

• Growth disorders in children with chronic inflammatory conditions can be mediated by multiple factors affecting the growth hormone-insulin-like growth factor I (IGF-I) axis, which is crucial for promoting linear growth at the growth plate 3
• While proinflammatory cytokines can adversely affect growth plate chondrogenesis, there is insufficient evidence that SSRIs specifically disrupt this process in a clinically significant manner 3

Clinical Implications

• Current pediatric guidelines for SSRI use do not include routine monitoring of growth parameters as a standard recommendation 1
• The AACAP guidelines focus on monitoring for more common and established side effects such as behavioral activation/agitation, suicidal ideation, and serotonin syndrome 1
• The American Academy of Pediatrics acknowledges that SSRIs are widely used in children but focuses on potential withdrawal symptoms in neonates rather than growth concerns 1

Monitoring Recommendations

• While routine growth monitoring is not specifically mandated for children on SSRIs, it represents good clinical practice to monitor growth parameters as part of regular follow-up for any child on long-term medication 1
• If growth velocity appears to decrease during SSRI treatment, evaluation of the growth hormone axis may be warranted 2
• The risk-benefit assessment should consider that untreated psychiatric conditions may themselves impact growth and development 1

Special Considerations

• When prescribing SSRIs to children, clinicians should focus on established monitoring parameters including:
  • Suicidal ideation (especially in first months of treatment and following dose adjustments) 1
  • Behavioral activation/agitation (more common in younger children than adolescents) 1
  • Potential drug interactions with other medications 1, 4
• The benefits of treating significant anxiety or depression typically outweigh the minimal and uncertain risk of growth effects 1