Short Stature - an Approach

Dr Swati Joshi
Important Terminologies & Facts While Evaluating Short Stature
Height Age: The age at which the patient's height is at the 50th percentile.

Bone age: Refers to the age at which the skeletal maturation shown in patient's radiographs is normally attained. Greulich Pyle charts are the most commonly used method, which examines the epiphyseal maturation of the hand & wrist.

Mid-parental height (MPH): The child's probable inherited growth potential can be estimated by mid-parental height percentile.
MPH range for boys = [(mother's height+13cm)+ father's height]/2 + 8cm
MPH range for girls = [Mother's height + (father's height- 13cm)]/2 + 8cm

Growth velocity / Height velocity: Observation of a child's height over a period of time or height velocity is the most important aspect of assessment of Short Stature. Since linear growth in children occurs in small episodic increments, there are inherent inadequacies in measuring linear growth. Therefore, determination of height velocity requires at least 6 months of observation.

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

(The Growth Velocity may fall to as low as 4cm/year just before the pubertal spurt)

A child's growth curve follows along the same channel or percentile from 2-9 years of age. The linear growth of normal infants (upto 8 months) may move to higher or lower percentile due to physiologic shift from intrauterine influences to the child's inherent growth potential. Crossing channels during puberty may be due to differential onset & extent of the pubertal growth spurt.

Thus, excepting infancy, subnormal growth velocity is the hallmark of postnatal pathologic short stature.

Various growth charts are available for monitoring the heights of which Tanner & Davis charts are widely used. WHO has adapted the NCHS growth charts as reference standards.

In India, the ICMR based on their multicentric study, have developed reference standards for growth. This study was predominantly done in lower socioeconomic sections, therefore reflects the growth characteristics of only these sections.

Data from study by Agarwal et al (1994) have provided reference data for well nourished children.

Short Stature - an Approach Short Stature - an Approach 02/23/2001
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