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ChildhoodGrowthandHeightIssues|Children'sHospitalofPhiladelphia

Childhood Growth and Height

Issues
What is the difference between short stature and
growth failure?

Shortstaturecomparesanindividualsheighttoareferencegroup,whilegrowthfailurerefers
toabnormallyslowgrowththatwillnotreachthegeneticallyexpectedadultheight.Theyoften,
butnotalways,occurtogether.Forexample,achildmayhaveshortstature(e.g.,height5th
percentileofotherchildrenhis/herageandgender)withoutgrowthfailure(i.e.,ifhis/her
parentsarealso5thpercentile).Likewise,achildmayhavegrowthfailurewithoutshortstature
(e.g.,heightpercentileforagefallingfrom90thpercentileto50thpercentile).
Are there any medical issues associated with children
who are very short but otherwise healthy?

Shortstatureisnotadisease.
Are there any underlying diseases associated with
children who are unusually tall?

Yes.Childrenwhoareinappropriatelytallfortheirfamiliesshouldalsobeevaluated.
What is constitutional growth delay?

Constitutionalgrowthdelayisthemedicaltermforlatebloomers.Theseindividualsarehealthy
andreachnormaladultheights,butgrowlaterthanotherchildren.
What is idiopathic short stature?

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Idiopathicshortstaturereferstoshortstaturewithoutanidentifiablecause.TheFDAapproved
growthhormonetherapyforchildrenwithidiopathicshortstaturetheheightcutoffisthe
bottom1percentileforage.
Should we expect a child to reach a nal height
between the heights of both parents?

BecausetheaveragemanintheUnitedStatesis5inchestallerthantheaveragewoman,we
cannotjusttaketheparentsheightswithoutcorrectingforgender.Childrenusuallyreacha
heightthatiswithin+/4inchesoftheaverageoftheirparentsheightpercentiles.This
assumesthattheenvironmentaleffectsongrowth,includingnutritionanddisease,remain
similarinbothgenerations.
How often should my child be measured?

AccordingtotheMarch2000RecommendationsforPreventativePediatricHealthCareby
theAmericanAcademyofPediatrics,achildsheightandweightshouldbemeasuredatleastat
birth,age24days,1,2,4,6,9,12,15,18and24months,andeveryyearthereafterthroughage
21.(Pediatrics2000105:645).
What are possible consequences of overlooking or
delaying the detection of an underlying disease that
causes short stature or poor growth?

Manydiseases(includinginfectious,gastrointestinal,kidney,heartandhormonal)canpresent
withgrowthfailuremonthsoryearsbeforeothersymptomsdevelop,sooverlookinggrowth
failureasaclinicalcluecanleadtodelayeddiagnosisandtreatment.Thismayadverselyaffect
outcomenotonlyforheight,butalsofortheunderlyingdiseaseandthechildsoverallhealth.
Forexample,longstandingunrecognizedanduntreatedceliacdisease,anintoleranceto
proteinsfoundinwheat,predisposesdevelopmentofotherautoimmuneconditions.Delayed
treatmentadverselyaffectsheightoutcomebecausegrowthcannotbefurtherimprovedonce
thegrowthplatesfuseattheendofpuberty.Sometimesdoctorswilltrytomedicallydelay
pubertytoallowmoretimeforgrowth,buttherearepsychosocialandbonehealthcoststo
delayingpubertyforyearsbeyondnormal.Thus,whetheritsadiseasewhoseimprovement
leadstocatchupgrowthoraconditionrequiringgrowthhormonetherapy,thefinalheight
outcomeisbetterwhenthetreatmentisstartedyounger.
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My son is the shortest boy in his class, and has been

ever since he started school. Should I have him
evaluated by a physician? If so, should I go straight to
a specialist?

Growthevaluationsbeginwithaccurateheightmeasurementsandcarefulplottingofagrowth
curve.Mostpediatriciansorfamilypractitionerskeepgrowthcurvesaspartofpediatric
primarycare.Thus,thebestplacetostartiswithyourchildsprimarydoctor.Thoroughhistory
andphysicalexaminationareneededtoevaluatefactorsthatcanimpactgrowth,suchasfamily
history,birthhistory,diseasesandmedications.Shouldanyconcernsberaised,thenreferralfor
furtherevaluationbyaspecialistiswarranted.
My daughter is shorter than most of the other girls in
her class, but people call her by adorable nicknames
and think shes so cute. Should I be concerned?

Theresnothingcuteaboutmissinganunderlyingdisease.Thesameparametersthatraise
concernaboutgrowthinboysalsoapplytogirls.
Are girls more likely than boys to have underlying
diseases that cause growth disparities?

No.Ourstudyfoundunderlyingdiseaseinahigherpercentageoftheabnormallyshortgirls
thanboys,butourstudywaslookingatchildrenreferredtoaspecialtyclinicandnotatthe
generalpopulation.Turnersyndrome,ageneticconditionthatcausesshortstature,occursonly
ingirls.Turnersyndromecaseswerenotenoughtoaccountforthedifferencefoundinour
study.
What information should I seek from my childs
pediatrician and what information should I have
available so that they can make an accurate
diagnosis?

Itisveryreasonabletolookatyourchildsgrowthcurvetogetherwithyourpediatrician.Afew
pediatriciansfeelthat,basedonexperience,theycanseewhichchildrenaregrowinglessthan
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normalwithoutthegrowthcurve.Whileseveregrowthfailuremaybeapparent,theyarelikely
missingmoresubtledeficits.
Itshelpfultogatherthefollowinginformationtoyourbestability:
Heightsofbothgeneticparents(withoutshoes)
Whetherbothparentswentthroughpubertyataverage,earlyorlateages
Familyhistoryofshortstature,latepubertyoranydiseases
Birthlengthandweightofthechild
Itisalsohelpfultoprepareyourchildforthevisitbyavoidinganyhairdosthatcaninterfere
withaccurateheightmeasurements(i.e.,stylesthatbunchuphairorusepins/bobsontopof
thehead).
If I am referred to a specialist, what materials should I
bring along to the appointment?

Youshouldbringacopyofyourchildsgrowthcurveaswellastheresultsofanylaboratoryor
Xraystudiesyourpediatricianhasalreadydonetoevaluateyourchildsgrowth.
Likewise,youshouldbringacopyofyourchildspriorgrowthcurvewheneveryouswitch
primarydoctorsorhaveaspecialistevaluationforproblemsotherthangrowth.
Are there any risks to treating a short child with
human growth hormone?

Growthhormonetreatmentisgenerallysaferthanmanymedications,butitisnotwithoutrisk.
Theseshouldbediscussedindetailwithyourchildsdoctorbeforepursuingtreatment.
Aren't there legitimate social or psychological reasons
for treating a short but healthy child with human
growth hormone?

Mostpeopleagreethatbeingveryshortcancausesomesocialstress,justlikebeingdifferent
fromanyothercause(eg.tootall,toofat,tooskinny,toobrainy,notsmartenough,notathletic

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enough,etc.).However,whetherthatwarrantsgrowthhormonetreatmentiscontroversial.In
anycase,attentionshouldbepaidtopromotingthechildsselfesteemandcopingmechanisms.
What is the most important nding in your study?

Ourstudyfoundthatsignificantlyfewergirlsthanboysarereferredforspecialistevaluationof
shortstatureorgrowthfailure.Ofthereferredchildren,thegirlswereshorterthantheboys
(relativetoboththegeneralpopulationandtheirparents)andweremorelikelytohavean
underlyingdisease.Thisdoesnotmeanthatshortgirlsaresickerthanshortboys,butthatthe
girlstendtobemoreseverelyaffectedthanboysbeforetheyseekspecialistcare.Thisislikely
duetosocialpressuresthatimplythatshortstatureisamoresignificantprobleminboysthan
girls.
GrimbergA,KatzJL,Kutikov,A,CucchiaraJ.Sexdifferencesinpatientsreferredforevaluation
ofpoorgrowth.JPediatr2005146(2):21216.Inpress.

2016ChildrensHospitalofPhiladelphia

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