Those with constitutional short stature have growth deceleration in the first two years of life, with normal growth velocity being achieved by age three and continuing throughout childhood. Skeletal maturity is delayed, and because timing of puberty correlates with skeletal age, both puberty and pubertal growth spurt are delayed. The growth spurt can be blunted, and consequently individuals with constitutional short stature often reach a final height at or just below the mid-parental target height. With familial as well as constitutional short stature, reassurance is often all that is needed. Patients with non-endocrine disease tend to have normal body proportions.
Chronic malnutrition is the commonest cause of poor growth globally.
In the developed world, malnutrition may occur as part of more complex disease - for example, inflammatory bowel disease, coeliac disease, or anorexia nervosa, rather than frank malnutrition. Short stature is also commonly associated with renal disease, and conditions associated with hypoxia or hypoxaemia, such as congenital heart disease, pulmonary disease, and haemoglobinopathies. Finally, psychosocial deprivation often causes short stature and delayed bone age with a delay in pubertal development are other features of the condition. Placing the child in a different environment results in growth catching up. Endocrine causes Growth hormone deficiency or insufficiency is an uncommon cause of short stature, with a prevalence of the condition being reported as 1 in 4000.