NHSGGC Paediatrics for Health Professionals
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Tall Stature: Advice for Referrers

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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
Information to Include - History
  • 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
Information to Include - Examination
  • Child’s current weight, height, and previous weight and height measurements to assess growth velocity, if available
  • BMI (weight in kg/height in metres squared) to assess associated overweight/obesity
  • If confident to perform, document pubertal staging
  • Signs of hyperthyroidism (goitre, tachycardia, exophthalmos)
  • Dysmorphic features
Suggestions for management whilst waiting for outpatient appointment
  • 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)
Useful resources for Parents

If problems with overweight/obesity signpost to Weigh to Go services

Useful resources for Health Professionals

Investigation and management of tall stature. Davies JH, Cheetham T. Archives of Disease in Childhood 2014; 99 772-777

Editorial Information

Last reviewed: 01 August 2022

Next review: 09 August 2025

Author(s): Dr Nike Osifodunrin, Consultant Medical Paediatrics