Many parents want to know if their child is growing normally or not. A child's growth is considered normal if both the height and weight for his/her age and sex are normal. Although weight is routinely monitored, little importance is given to height of the child. The term short stature refers to any child who has a height well below the average for his/her age and sex. This term is most commonly applied to children whose height, when plotted on a growth curve, is below the line marking the 3rd percentile.

Weight loss in a child indicates an acute medical condition of short duration. However, if a child has short stature, it often indicates that a child has chronic medical condition of longer duration. Such children with proper medical care and appropriate treatment can achieve normal growth.

While change in weight is easily recognized by parents, change in height is not appreciated till the child is signicantly short. This is the reason, most experts recommend routine monitoring of not only weight but also height in all children.

Is your child short?

Identication of short stature is done by using a growth chart (2015) recommended by the Indian Academy of Pediatrics. See Backside for IAP Growth Chart for Boys (in Blue) and Girls (in Pink) This growth chart uses lines to display an average growth path for a child of a certain age, sex, and height. Each line indicates a certain percentage of the population that would be that particular height at a particular age. A boy with a height that is plotted on the 25th percentile line, for example, indicates that approximately 25 out of 100 boys of his age are shorter than him. A child that has a height plot that is below the 3% line is considered to have short stature. Such children need evaluation by an Endocrinologist to identify the cause of short stature.

Reasons for short stature

A child can remain short due to any of the following reasons:

  • Familial short stature - if one or both parents are short
  • Constitutional delay in growth and puberty - In this condition, the child remains short but has late catch up of growth and achievement of normal adult height.
  • Chronic medical conditions
  • Endocrine conditions like growth hormone deciency, thyroid hormone deciency, etc
  • Genetic conditions like prader willi syndrome, turner syndrome, etc
  • Medications like steroids used for arthritis or asthma
  • Poor nutrition
  • Babies with a history of being born small (small for gestational age or with a history of intrauterine growth retardation)
  • Idiopathic short stature

Investigation for short stature

The best "test" is to monitor the child's growth over time using the growth chart. The height of the parents is an important indicator of how tall a child is likely to grow as an adult. The term mid-parental height refers to the height that a child is likely to achieve as an adult and is calculated by a simple formula based on parent's height. A child born to parents who are short will most likely grow with nal adult height below average. Six months is a typical time frame for children, and if the rate of growth is clearly normal no additional testing may be needed. If growth velocity is less or if the child is severely short, Endocrinologist will do certain tests to assess the cause of short stature as mentioned above. Your Endocirnologist may also ask for bone age assessment which is done by taking an X-ray of the left hand and the wrist.

Endocrinologist also take into consideration the values of a child's growth referred to as the growth velocity. Growth velocity of a child aged 4 to 10 years is fairly constant between 5 - 7 cms per year. If the growth velocity drops, it indicates that the child has some cause of growth failure and needs immediate attention by Endocrinologist.

Treatment for short stature

The most common cause of short stature is CDGP(constitutional delay in growth and puberty). Making a diagnosis of CDGP needs expertise. If your Endocirnologist makes a diagnosis of CDGP, then you do not have to worry about the future growth potential which is likely to remain normal without any hormonal treatment. Generally the treatment depends on the cause of short stature, e.g., thyroxine supplementation for thyroxine deciency, growth hormone supplementation for growth hormone deciency.

Growth Hormone treatment for short stature

Growth hormone is indicated only if growth hormone deciency is conrmed biochemically by special tests. Treatment with growth hormone in such children increases their height by 8 - 13 cm in the rst year of treatment. Growth hormone is also approved for medical conditions other than growth hormone deciency like idiopathic short stature, turner syndrome, chronic kidney disease, small for gestational age babies, etc.

To summarize, height is also one of the important measurements to assess child's growth in addition to weight. Height needs to be checked and plotted in the growth chart every 3months to identify any growth related problems. Early identication and appropriate treatment by Endocrinologist helps in catching up with the growth for such children and have better outcomes.

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