Approach to a child with short stature
Approach to a child with short stature
Introduction:
- Short stature is not a disease; it is a term applied to a child who is 2SD (Standard Deviations) or more below the mean height for children of that sex and chronologic age (and ideally of the same racial-ethnic group). This translates into being below the 3rd percentile for height. 
- Growth failure denotes a slow growth rate regardless of stature.
- A single measurement of height is much less important in assessing growth than is the pattern of growth over a period of time.
- Our main goal in evaluation of short stature; is to distinguish pathological short stature from non-pathological.
Important points to be addressed in history:
- Size at birth & pattern of growth:
- Family history & parental height:
- Pregnancy problems:
- Nutritional history: adequate caloric intake and drinking & eating habits (for under-nutrition).
- Age of puberty (for constitutional delay).
- History of chronic disease:
- Symptoms of hypothyroidism (cold intolerance, weight gain ...etc.)
- Glucocorticoid therapy. 
- Visual symptoms, headache & menstrual irregularities: suspected pituitary tumors.
- Polyuria, polydipsia, vomiting, early morning nausea: for suspected CNS masses.
- Milestones delay: for GH deficiency.
- Psychological problems (emotional deprivation, social withdrawal...etc.): for Psychological short stature.
Physical exam:
- Growth parameters: Height, weight, head circumference & plot them on appropriate growth charts.
- Dysmorphic features:
- Calculate Growth velocity:
- Calculate upper: lower segment ratio:
- Measure arm span:
- Inspect the 4th metacarpal for pseudo-hypoparathyroidism.
- Visual field exam.
- Thyroid exam and signs of hypothyroidism.
- Central obesity & striae: for suspected Cushing's syndrome.
- Secondary sexual characteristics: for suspected precocious puberty.
- Truncal obesity and micropenis: for GH deficiency.
Clinical approach:
- 1st step in evaluation of short stature is taking appropriate history and doing proper physical examination as above.
- Plot the height of the child on appropriate growth chart to establish the diagnosis of short stature.
- Look for any dysmorphic features:
- Calculate Growth velocity.
References:
1.         Cohen P, Rogol AD, Deal CL, et al. Consensus statement on the diagnosis and treatment of children with idiopathic short stature: a summary of the Growth Hormone Research Society, the Lawson Wilkins Pediatric Endocrine Society, and the European Society for Paediatric Endocrinology Workshop. J Clin Endocrinol Metab. Nov 2008;    93(11):4210 -7. .
2.       Karlberg JP, Albertson-Wikland K, Kwan EY, et al. The timing of early postnatal catch-up growth in normal, full-term infants born short for gestational age. Horm Res 1997; 48 Suppl 1:17.
3.       Karlberg JP, Albertson-Wikland K. Growth in full-term small-for-gestational-age infants: from birth to final height. Pediatr Res 1995; 38:733.
4.       Paz I, Seidman DS, Danon YL, et al. Are children born small for gestational age at increased risk of short ststure? Am J Dis Child 1993; 147:337.
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6.       Ozer G, Yuksel B, Kozanoglu M, et al. Growth and development of 280 hypothyroidic patients at diagnosis. Acta Paediatr Jpn 1995; 37:145.
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8.       Rogol, AD, Lawton, EL.Body measurements. In:pediatric outpatient procedures, Lohr, JA(Ed), JB Lippincott, Philadelphia 1991.p.1.
9.       Kaplan SL, Grumbach MM. Clinical review 14: Pathophysiology and treatment of sexual precocity. JClin Endocrinol Metab 1990; 71:785.
10.   Clinical pediatric endocrinology by Charles Groves Darville Brook, Peter E. Clayton, Rosalind S. Brown.
11.   Stedman's Medical Dictionary. Copyright C 2006 Lippincott Williams & Wilkins.