stature is a common reason for referral to the paediatric clinic and can be of
considerable concern to parents and young people. The most common definition of short stature is
a height which is two or more standard deviations below the mean (<2nd
centile) for age and gender; the further
away from the population mean the child’s height lies the more likely it is
that they will have an underlying pathology.
It is important not just to look
at a single height measurement but to consider whether a child is growing
slowly or if they are inappropriately small compared to their family.
short children do not have an underlying organic cause but a combination of
familial short stature and constitutional delay of growth and development. However, in some children, short stature is a
manifestation of an underlying chronic medical condition or a primary growth
disorder. Boys tend to come to medical attention more
frequently than girls but the chances of finding an underlying cause are
similar in both.
It is useful
to plot height on an age and sex appropriate centile chart.
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.
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
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
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.
measurements are tricky in the first 2-3 years of life and infants can cross
centile lines during this period.
infancy children should grow parallel to a centile line
there a difference between height and weight centiles?
important in infancy as nutrition is the key determinant of growth during
surgery for hernia, undescended testes
e.g regular steroid preparations
and sibling height, delayed puberty in either parent, consanguinity, history of
effect is the short stature having on the child?
to make a judgment about short stature in older children without knowing their
of underlying chronic disease
assessment (if appropriate)
height centiles (this can be normal during infancy)
with short stature
or minimal growth
of chronic illness
A well child with a normal examination and a height that lies within the parental target can often be reassured without any investigations. If there any concerns about the growth pattern or the history, then baseline bloods and wrist x-ray to assess bone age can be carried out. Please consider x ray of left hand and wrist for bone age – this can be requested as ‘x ray hand and bone age’. Assessment of short stature often requires serial measurements over a period of several months or even years.
majority of children referred with short stature will not require any
treatment. Chronic illness will be
diagnosed and managed appropriately with specialist input as required. Growth
hormone treatment or medication to progress puberty will only be started for clearly
defined reasons as per national guidelines.
Any hormone treatment will be initiated by a paediatric endocrinologist
or a paediatrician with a special interest in growth and puberty disorders.
useful investigation in the assessment of short stature is serial measurements
plotted on a growth chart (see above) so parents should be encouraged to fill
in the red book if possible. It is also helpful if both parents have had their
heights measured in centimetres, and that of any other children in the family,
and they bring these measurements to their first clinic appointment.
Initial referrals should be made to general paediatric outpatients via ERS. If you are uncertain about referring please contact the paediatric team via Advice & Guidance on ERS for advice.
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