RHC for Health Professionals
- Birth history- abnormalities of foetal growth, birth weight, gestational age, perinatal complications
- Child’s height trend - when did the parents first notice child was tall?
- Parents’ and siblings’ heights and age of onset of puberty
- Pubertal history
- Current medications
- Nutrition- is diet contributing to growth/obesity?
- Any evidence of hyperthyroidism – e.g. feeling hot, tremors
- Any evidence of intracranial causes – e.g. headaches, visual disturbance
Tall Stature: Advice for Referrers
Warning
Tall stature is defined as a height greater than two standard deviations above the mean for gender and age. Most commonly tall stature is physiological and it is only rarely caused by an endocrine issue. Children 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 7cm
- 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 issues with obesity/diet: give guidance on healthy diet or referral to weight management services (Weigh-to-Go).
- 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)
If problems with overweight/obesity signpost to Weigh to Go services
Davies JH, Cheetham T. Investigation and management of tall stature. Archives of Disease in Childhood 2014; 99 772-777