Investigation and Management of Short Stature
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 has been estimated that around 1 in 5 children with a height less than 2 SD below the mean (2nd centile) and around half the children with a height less than 3 SD below the mean will have a pathological reason for their small size. The exact figure will depend upon the nature of the population studied and the reference standards used. Similarly, the slower a child is growing, the more likely it is that they will have an underlying pathology. The child's current height (length in the case of the infant) together with earlier measurements should be plotted on appropriate reference charts and be further placed into context by comparing this with the parental target. The likelihood of pathology in the short child of shorter parents will be different to a child of the same size who has taller parents. Many contemporary charts have details of how to do this but, essentially, a point that is half-way between the mother's and father's heights on the centile charts (ideally measured rather than reported) is used to generate a range between which most of the couples' children can be expected to lie. The phenomenon of 'regression to the mean' whereby short parents tend to have children who are not as short as they are should also be borne in mind. Some standards include a correction that takes this into consideration when calculating the parental target. It is helpful to show the growth chart to the child and parents and to explain how the child's height compares with the population and to that expected given parental size.
There are a number of fundamental questions to ask as part of the initial assessment in addition to establishing who it is that is concerned in the first place. Establishing the child's birth weight will help to indicate whether short stature could be linked to poor growth in utero (was the child small for gestational age at birth?). By the age of 4 years, around 10% of children born with a low birth weight (<−2 SDS or the 2nd centile) will stay short with no substantial 'catch-up' growth. Babies with extremely low birth weight are particularly at risk of this growth pattern. Finding out whether the child is well or not is clearly important although there may be discrepancy between what the child thinks and what parent(s) think.
Initial Assessment
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 has been estimated that around 1 in 5 children with a height less than 2 SD below the mean (2nd centile) and around half the children with a height less than 3 SD below the mean will have a pathological reason for their small size. The exact figure will depend upon the nature of the population studied and the reference standards used. Similarly, the slower a child is growing, the more likely it is that they will have an underlying pathology. The child's current height (length in the case of the infant) together with earlier measurements should be plotted on appropriate reference charts and be further placed into context by comparing this with the parental target. The likelihood of pathology in the short child of shorter parents will be different to a child of the same size who has taller parents. Many contemporary charts have details of how to do this but, essentially, a point that is half-way between the mother's and father's heights on the centile charts (ideally measured rather than reported) is used to generate a range between which most of the couples' children can be expected to lie. The phenomenon of 'regression to the mean' whereby short parents tend to have children who are not as short as they are should also be borne in mind. Some standards include a correction that takes this into consideration when calculating the parental target. It is helpful to show the growth chart to the child and parents and to explain how the child's height compares with the population and to that expected given parental size.
There are a number of fundamental questions to ask as part of the initial assessment in addition to establishing who it is that is concerned in the first place. Establishing the child's birth weight will help to indicate whether short stature could be linked to poor growth in utero (was the child small for gestational age at birth?). By the age of 4 years, around 10% of children born with a low birth weight (<−2 SDS or the 2nd centile) will stay short with no substantial 'catch-up' growth. Babies with extremely low birth weight are particularly at risk of this growth pattern. Finding out whether the child is well or not is clearly important although there may be discrepancy between what the child thinks and what parent(s) think.