A Family's Guide to Starting Daily Growth Hormone for Endocrine

Important information:

Treatment overview

Your child’s endocrine provider has recommended growth hormone treatment. After the medicine is prescribed, the endocrinology team works together to make sure your child can safely start treatment.

Once treatment begins, your child will likely grow more quickly within the first few months. Clothes and shoes may be outgrown faster, and hair and nails may grow faster. Your child may also lose baby teeth sooner and may have a bigger appetite. A balanced diet is important, but no special foods or supplements are needed. Sleep patterns usually do not change.

Insurance approval process

The reimbursement team at Children's Hospital of Philadelphia (CHOP) Specialty Pharmacy completes an insurance review to determine coverage and identify the pharmacy/distributor of the medication.

Insurance review and shipment can take time. The process often takes 4 to 6 weeks and may take longer if insurance first denies coverage.

If insurance does not approve the growth hormone, your provider will decide the next steps. This may include trying another treatment or appealing the decision. Appeals can take up to 3 months and are not always approved. You will be told if you need to share any additional information.

If you do not hear anything in 4 weeks, call the Growth Center coordinator in the Endocrinology Department at 215-590-3174 and follow the prompts.

Growth hormone brands and insurance coverage

CHOP does not have a preferred brand of growth hormone. Your insurance company decides which brands are covered by your plan. Sometimes, insurance companies change their preferred brand during treatment.

If you learn that your insurance coverage or formulary has changed, call the Endocrine office as soon as possible. The team will work with you, your insurance company, and the pharmacy or distributor to make sure the transition to a new brand goes smoothly.

Pharmacy and shipment

If insurance approves the growth hormone, it will be supplied through a homecare company or mail-order pharmacy. Most local pharmacies do not carry growth hormone. The insurance company decides which pharmacy will fill the prescription.

If CHOP Specialty Pharmacy is the distributor, they will call you to set up a shipment date and provide instructions.

If another specialty pharmacy is assigned, your provider will send the prescription there.

The CHOP precertification coordinator will tell you which pharmacy is assigned and explain how to set up your account.

Storage and handling

Most growth hormone brands must be kept in the refrigerator. Always check the manufacturer’s instructions for how to store and handle the medicine.

When traveling or sending your child to camp, keep the medicine cool with ice packs. Camp staff can give injections if they have been trained.

Baseline height measurement

Your child needs a current height measurement before starting treatment. This helps track how the medicine affects growth. If it has been more than 3 months since the last measurement, a new height must be taken in the Endocrine Clinic before treatment begins.

Injection information

  • Schedule a training session. After you receive the medicine, call the Family Learning Center (FLC) at 215-590-6078 to schedule a training session. Two adults and your child should attend, if possible. Bring the medicine and injection supplies to the class (or have them ready if virtual). Keep the medicine chilled during travel. You will give your child the first injection during the class.

  • Growth hormone works best when given between dinner and bedtime, since it naturally acts overnight. Giving it earlier in the evening is fine if bedtime is not possible. If your child is prescribed growth hormone to help manage low blood sugar, the injection schedule may be different. Your health care provider will explain exactly when to give each dose.

  • Injections are given under the skin (subcutaneous). Any area of the body approved for subcutaneous (SUBQ) injections can be used for growth hormone. During your training session, you will receive instructions on which sites to use and how to rotate them properly.

  • If you ever miss an injection, it will not harm your child, but it may slow growth. Importantly, if your child is taking growth hormone to manage low blood sugar and misses a dose, closely monitor their blood sugar and contact your health care provider or the on-call endocrine fellow (after hours) with any questions or concerns.

  • If you do not have enough medicine for a full dose, do not throw away the leftover amount. You will learn what to do with partial doses during your training.

  • Your child can continue injections while sick. If your child feels too unwell, you may skip a dose. For children with low blood sugar, talk with your endocrine provider before stopping treatment.

Side effects and safety

Most children tolerate growth hormone well. Possible side effects include:

  • Mild allergic reaction (rash, swelling, or hives)

  • Mild joint pain that does not limit activity

  • Puffy hands or feet from fluid retention

  • Headaches, especially if your child had them before

  • Worsening of existing scoliosis

  • A slight increase in blood sugar levels (monitored during treatment)

Call the Endocrine Clinic right away if your child has:

  • Severe headache or blurry vision

  • Vomiting

  • Limping

  • Severe hip, knee, or leg pain

  • Severe abdominal pain

Follow-up appointments

Once treatment starts, your child will need routine follow-up visits every 3 to 5 months to check growth, development, and any side effects. The first visit should be scheduled 3 to 4 months after starting treatment.

Blood tests are done every 6 to 12 months, and a bone age X-ray is usually done once a year.

Bring the following to every visit:

  • Name of the growth hormone medicine

  • Name of the pharmacy or distributor

  • Size of the medicine cartridge

  • Dose of the medicine

  • Needle size (gauge and millimeters)

If your child is prescribed new medicine, especially steroids like prednisone, check with your pharmacist and endocrine provider first. Over-the-counter medicines are safe to use.

If you have questions or concerns, contact your endocrine provider at 215-590-3174 or send a message through MyCHOP.

 

Reviewed December 2025 by Vaneeta Bamba, MD, Eileen Barthelmes, RNC