It is useful
to plot height on an age and sex appropriate centile chart.
For children
up to 4 years these are available in the Personal Child Health Record (‘red
book’). For premature infants (earlier
than 32 weeks) it is important to plot their growth on specific charts designed
to account for their gestational age.
Growth charts for older children (2-18 years) can be downloaded from the
RCPCH website https://www.rcpch.ac.uk/resources/uk-who-growth-charts-2-18-years.
The UK-WHO
growth charts include instructions for predicting adult height based on the
child’s current height, and guidance on mid-parental height centile. Demonstrating a predicted adult height which
is similar to parental height may be sufficient reassurance for parents and
children. However further assessment may
be required if growth velocity has slowed or height is lower than
expected.
History
Short
stature in itself is not an emergency; however it may be symptomatic of an
underlying medical problem requiring urgent treatment and a thorough history is
therefore important.
- Birth
history:
- Pregnancy,
delivery, birthweight, perinatal history, neonatal problems
- Pattern of
growth:
- Small
for gestational age at birth – by 4 years, around 10% of children born <2nd
centile will stay short and not have shown substantial catch up growth.
- Length/height
measurements are tricky in the first 2-3 years of life and infants can cross
centile lines during this period.
- Beyond
infancy children should grow parallel to a centile line
- Is
there a difference between height and weight centiles?
- Assess
nutrition
- Particularly
important in infancy as nutrition is the key determinant of growth during
infancy
- Symptoms of
chronic illness
- Past
medical history
- Including
surgery for hernia, undescended testes
- Medication
- e.g regular steroid preparations
- Family
history
- Parental
and sibling height, delayed puberty in either parent, consanguinity, history of
endocrine disorders
- Social
details
- What
effect is the short stature having on the child?
- Pubertal
status
- Difficult
to make a judgment about short stature in older children without knowing their
pubertal stage
Examination
- Any
dysmorphic features?
- Evidence
of disproportion
- Signs
of underlying chronic disease
- Pubertal
assessment (if appropriate)