Pediatric Endocrine Overview
Hormones run growth and metabolism — too little or too much causes trouble.
Hormones are chemical messengers that control growth, metabolism, and fluid and electrolyte balance. In children, two stakes are especially high: normal growth and brain development, and steady blood glucose. Most endocrine problems come down to too little or too much of a hormone, and several — like congenital hypothyroidism — are caught early by routine newborn screening.
Sort each disorder by whether a hormone is deficient (type 1 diabetes = little/no insulin; congenital hypothyroidism = low thyroid hormone; growth hormone deficiency) or in excess. In children the priorities are protecting growth and brain development and keeping blood glucose steady — and catching problems early.
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Type 1 Diabetes Mellitus
An autoimmune loss of insulin — so insulin is the treatment.
Type 1 diabetes mellitus is an autoimmune disorder in which the body destroys the insulin-making cells of the pancreas, so the child makes little or no insulin and needs insulin for life. (This is different from type 2, which is mainly insulin resistance.) Without insulin, glucose can't move into the cells, so it builds up in the blood and spills into the urine.
Classic Signs — the 3 P's
- Polyuria (urinating a lot — including new bedwetting), polydipsia (very thirsty), and polyphagia (very hungry)
- Unexplained weight loss, fatigue, and blurred vision
- May first show up as diabetic ketoacidosis (DKA)
Management: insulin (the only treatment for type 1), blood glucose monitoring, carbohydrate counting, and balancing food, activity, and insulin. See the Endocrine & Diabetic Medications guide for insulin types, peaks, and mixing.
The classic triad of new type 1 diabetes is polyuria, polydipsia, and polyphagia — peeing, drinking, and eating a lot — usually with weight loss and fatigue. A child who suddenly starts wetting the bed again may be showing polyuria. Type 1 always needs insulin; it can't be managed with diet or pills alone.
Diabetic Ketoacidosis (DKA)
Not enough insulin → the body burns fat and makes acid.
Diabetic ketoacidosis is a life-threatening emergency that happens when there isn't enough insulin, so the body burns fat for fuel and produces acidic ketones. It often appears at the first diagnosis of type 1 diabetes, or during illness or missed insulin.
Signs
- High blood glucose and dehydration
- Kussmaul respirations (deep, rapid breathing) and fruity (acetone) breath
- Abdominal pain, nausea and vomiting, and a declining level of consciousness
Management order: IV fluids first to rehydrate, then a regular insulin IV infusion to lower the glucose gradually, plus electrolyte replacement and close monitoring.
The first priority is IV fluids, then a regular insulin drip. As insulin drives glucose into the cells it also drives potassium in, so the blood potassium can fall quickly — monitor it closely. Deep, rapid Kussmaul respirations and fruity breath are the classic clues.
? A child with type 1 diabetes presents with deep rapid breathing and fruity breath. What is the first priority intervention?
Hypoglycemia & the Rule of 15
Low glucose comes on fast — and the brain needs sugar now.
Hypoglycemia (low blood glucose) can come on quickly from too much insulin, a missed or delayed meal, or extra activity. It is an emergency because the brain depends on a steady supply of glucose.
Signs
- Shakiness, sweating, pallor, fast heartbeat, and hunger
- Irritability, confusion, and headache
- If severe: seizures or loss of consciousness
If the child is awake and able to swallow, give 15 grams of fast-acting carbohydrate (about 4 oz of juice, glucose tablets, or regular soda), wait 15 minutes, and recheck the glucose. Repeat if it is still low, then follow with a snack or meal. If the child is unconscious or can't swallow, give nothing by mouth — give glucagon (IM/subcutaneous) or IV dextrose.
Congenital Hypothyroidism
Too little thyroid hormone at birth — and the brain is on the line.
Congenital hypothyroidism means a baby is born with too little thyroid hormone. Because thyroid hormone is essential for brain growth and development, catching it early is critical — which is why it is part of routine newborn screening.
Signs in a Newborn
- Often few signs at first, then prolonged jaundice, poor feeding, and lethargy
- A large, protruding tongue, a hoarse cry, and constipation
- Cool, mottled skin and poor muscle tone (hypotonia)
Treatment: levothyroxine (thyroid hormone replacement), started as early as possible and continued for life.
Untreated congenital hypothyroidism causes permanent intellectual disability and growth failure. Because newborn screening catches it before symptoms are obvious, levothyroxine must be started early — prompt treatment allows normal brain development.
Give it once daily. Crush the tablet and mix it in a small amount of breast milk, formula, or water — not a full bottle — so the baby gets the entire dose. Avoid giving it at the same time as soy formula or iron, which reduce absorption. It is a lifelong medication.
Growth Hormone Deficiency
Slow growth and short stature — but normal proportions.
In growth hormone (GH) deficiency, the pituitary gland doesn't make enough GH, so the child grows slowly and is much shorter than peers — but with normal body proportions and normal intelligence. Growth often falls off the expected curve over time.
Treatment: growth hormone injections, given regularly. Timing matters: GH only increases height while the growth plates (epiphyses) are still open, so it must be started before puberty finishes.
Growth hormone is given by subcutaneous injection and only works before the growth plates close. That's why early diagnosis matters — once the epiphyseal plates fuse at the end of puberty, added GH can no longer increase height. The nurse plots growth and supports the family with the injection routine.
Nursing Care & Teaching
The shared priorities across pediatric endocrine problems.
- Blood glucose & diabetes care — monitor glucose, teach insulin technique and site rotation, carbohydrate counting, and sick-day rules; teach the family to treat lows with the Rule of 15.
- Recognize the emergencies — DKA (Kussmaul breathing, fruity breath → fluids first, then insulin) and severe hypoglycemia (glucagon if unconscious).
- Medication adherence — levothyroxine and growth hormone are long-term or lifelong; teach correct administration and not stopping without guidance.
- Growth & development — plot height and weight, support body image, and involve the child in self-care as they grow.
- Family teaching — newborn-screening follow-up, when to call the provider, and carrying fast carbohydrates and medical ID.
Match the hallmark to the disorder: 3 P's + weight loss = new type 1 diabetes; Kussmaul breathing + fruity breath = DKA (IV fluids first, then insulin, watch potassium); shaky, sweaty, confused = hypoglycemia (Rule of 15); newborn screening + large tongue, lethargy, prolonged jaundice = congenital hypothyroidism (start levothyroxine early); short stature with normal proportions = growth hormone deficiency.
Frequently Asked Questions
Common student questions on this topic.
What are the signs of type 1 diabetes in a child?
What is the priority treatment for diabetic ketoacidosis (DKA)?
What is the Rule of 15 for hypoglycemia?
Why must congenital hypothyroidism be treated early?
How is levothyroxine given to an infant?
How is growth hormone deficiency treated?
Quick-Reference Cheatsheet
Every key point from this guide on a single printable page.
Pediatric Endocrine Disorders Cheatsheet
One-page PDF — free download.