RHC for Health Professionals
- Antenatal history- maternal health, medications, smoking
- Birth history- abnormalities of foetal growth, gestational age, birth weight, perinatal complications
- Symptoms of chronic disease including diarrhoea, abdominal pain (inflammatory bowel disease, coeliac disease), headaches, visual disturbance, fatigue, uncontrolled asthma, or concerns of a genetic disorder (Turner, Prader-Willi, Noonan, Russel-Silver)
- Medications- including steroids (Inhaled/oral therapy - length and dose of treatment)
- Nutrition- Is diet intake appropriate for adequate growth?
- Development and Social history- any concerns about psychosocial deprivation
- Signs of puberty
- Previous height measurements. Assess whether the child is petite but has been growing consistently, whether there is recent growth faltering, or whether the growth has been stunted for some time
- Family history of short stature or genetic concerns
- Parents’ and siblings’ heights and ages of pubertal onset
Short Stature: Advice for Referrers
Warning
Short stature is defined as any child who has a height below the 0.4th centile on a growth chart or less than 2 standard deviations below the mean for gender and age.
The majority of cases are variation of normal physiological growth such as familial short stature, constitutional delay and idiopathic short stature. A single point on a growth chart is not definitive of short stature. As a result, previous growth data and serial measurements should be plotted.
Pathological causes of short stature include genetic syndromes (Prader-Willi syndrome, Turner syndrome, Noonan syndrome), chronic diseases, and endocrine pathology.
Children’s whose heights fall within their expected adult height, and who are well, do not need further investigation.
A child’s mean expected adult height is calculated as follows:
Boy: The mean of the parents’ heights plus 7 cm.
Girl: The mean of the parents’ heights minus 7 cm.
- If it is possible then the following baseline investigations would be useful: Full blood count; ESR; CRP; electrolytes; Bone biochemistry (Ca/Phosphate/ALP); Urine culture and dipstick; TSH/freeT4; Ferritin, Coeliac screen
- Measure height at 4 monthly intervals to assess height velocity
- If nutrition is inadequate, refer to dietitian for guidance on nutritional intake. Keep a diary recording food intake (types and amounts) and mealtime issues (for example, child’s behaviour) to help with management strategies and assess progress
- It would be helpful for the child to have their eyes checked by an optician prior to their appointment (including accurate assessment of visual fields)
It is important to recognize the emotional impact of short stature on parents, carers and children/young people. Good communication in these cases is important.
Cheetham T, Davies JH. Investigation and managmenet of short stature. Archives of Disease in Childhood 2014;99:767-771