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Approach to a Child with Short Stature

Definition of Short Stature

Short stature refers to the height below 3rd Centile or 2 Standard Deviations (-2 SD) or more below the mean height for chronological age and gender for the standard population.

When height is >-3 SD it’s most likely pathological.

Assessment of Short stature

1. Accurate height measurement: using Stadiometer for <2yrs and on Frankfurt plane for older children.

2. Assess height velocity: cm/year

3. Mid-parental height: Estimated Final Height = 

4. Assessment of Body Proportion: Upper segment to Lower segment ratio – Normal, low or high

5. Sexual Maturity Rating: Normal, Delayed or Advanced

Etiological Assessment and Classification of Short Stature

CDGP: Constitutional delay in Growth and puberty

It can be classified on the basis of Upper : Lower segment ratio and then further into Physiological and Pathological causes.

Keeping in mind the causes – history should be sought for Low birth weight, IUGR, Family history of short stature (Achondroplasia, Familial short stature), Delayed puberty and menstruation (CDGP), Bowing of legs and skeletal deformities (Skeletal dysplasias).

Symptoms:

Systemic:

Neonatal history: hypoglycemia, jaundice, micropenis

Any chronic illness, drug or hormone intake

Social environment

Examination:

Evaluation of Short Stature

1. Assess Bone Age and tally with Chronological age: Bone age is assessed by Tanner’s and Whitehouse method or Gruelich-Pyle atlas.

Delayed Bone age compared to Chronological age: All organic cases

a. Bone age proportionate to height age:

b. Bone age is less than height age:

c. Bone age is Normal for Chronological Age: Familial Short stature

d. Advanced Bone Age:

2. Investigations:

If Height is not below 2 SD: no evaluation – weight and watch 3-6 monthly

If Height <-2 SD, look for SD score:

If Normal Proceed with:

Management of Short Stature

1. For CDGP and Familial type: Counselling

2. GH therapy for GH deficiency, failure to catch-up, Low birth weight children

GH is currently approved in the United States for treating children with growth failure as a result of Turner syndrome, end-stage renal failure before kidney transplantation, Prader-Willi syndrome, intrauterine growth retardation, and idiopathic short stature.

3. As per pathology for other causes.

References:
1. Nelson Textbook of Pediatrics
2. OP Ghai Essentials of Pediatrics
3. Review articles

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