Child With Short Stature Silent Features,History,Examination

4th Pediatric Infectious Diseases Conference

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APPROACH TO A CHILD WITH SHORT STATURE

Related topics

Child With Short Stature

Terminologies and Facts while Evaluating Short Stature

Child with Short Stature Etiology

Clinical Evaluation

Investigations of Short Stature

Dr Swati Joshi,
Lecturer (Endocrinology and Epilepsy)
B J Wadia Hospital for Children,
Mumbai.

Silent features of Normal Variant Short Stature :-

	FSS	CGD
Sex	-	Commoner in boys
Birth Height	Less	Normal
Family History	History of short stature -positive	Delayed puberty especially in father
Growth Velocity	Growth Velocity	Growth Velocity normal for bone age.
Bone Age	Normal	Slight delay / BA = HA
Final adult height	short	Normal

Are there any specific stigmata/ clues on history & examination?

HISTORY		ETIOLOGY
History at Presentation	Fever, weight loss, anorexia	Chronic infection
	Chronic diarrhea/ bulky frothy stools	Malabsorption
	Dyspnea, cough, cyanosis	Asthma, TB, CHD
	Headache/ vomiting/ diplopia	Intracranial tumors (Craniopharyngioma)
	Polyuria, polydipsia	Diabetes insipidus, mellitus, RTA
	Weight gain, obesity	Cushing's syndrome
	Constipation,delayed milestones,lethargy	Hypothyroidism
Birth History	Low birth weight	IUGR, dysmorphic syndromes
	Birth asphyxia, breech presentation, Neonatal hypoglycemia, icterus	Growth Hormone Deficiency
Dietary History	Poor protein caloric intake	Malnutrition / Rickets
Family History	Short stature in sibs/ parents/cousins	FSS
	Delayed puberty	CGD
Psychosocial	Emotional problems	Psychosocial dwarfism
EXAMINATION		ETIOLOGY
Increased respiratory rate		CHD, Asthma, IEM (acidosis)
Increased BP		Cushing syndrome, CNS tumors, CRF
Pallor		Chronic Anemia, CRF, Hypothyroidism
Rickets		Nutritional Vit D def, RTA
Disproportionate Body proportions		Skeletal dysplasias, Rickets
Decreased Weight for height		Malnutrition
Frontal bossing, midfacial crowding, micropenis, truncal obesity		Growth hormone deficiency
Coarse skin, delayed relaxation of jerks, + goitre, bradycardia		Hypothyroidism
Papilledema, visual field defects		Tumors- craniopharyngioma
Central obesity, striae, hypertension		Cushing syndrome
Female with webbed neck, Cubitus valgus, shield chest		Turner syndrome
Male / female with triangular facies, webbed neck, ptosis, pectus excavatum & pulmonary stenosis		Noonan Syndrome
Small triangular facies, hemihypertrophy, clinodactyly		Russel Silver syndrome
Bird headed dwarfism with small face, large eyes, microcephaly & micrognathia		Seckel syndrome
Brachycephaly, simian crease, large tongue		Down's syndrome

Next : Investigations of Short Stature

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