Short and obese: hormone deficiency, syndrome.Age 2-13: shifts across 2 growth chart lines are abnormal.Less than Age 2: shifts across lines are normal.Intrauterine growth restriction (IUGR) vs.Is growth truly delayed? Use mid-parental height growth potential prediction and determine appropriate normal range.Growth charts are very helpful for assessing growth velocity, including weight and height, and comparison to the mid-parental height. Genitourinary – accurate Tanner staging.Chest – widely spaced nipples, pectus excavatum or carinatum, breast development.Dysmorphic features – palate, ear placement, size / shape of hands and feet.Head and neck – for maturation (acne, facial hair), goiter.General systemic examination including lungs, heart, abdomen, neurologic systems.General examination – weight and height measurement and plot on the appropriate growth chart body proportions – arm span, upper-to-lower body ratio, head circumference.Check for factors that many influence normal growth, including sleep, exercise, and psychosocial factors such as a sense of security and of being loved.Ask about usage of methylphenidate or other such stimulants, antidepressants, or anticonvulsants.Include ear and urinary tract infections, poor appetite, diarrhea, trauma, surgery, or hospitalizations.Check for sufficient calories, calcium, protein, and vitamins.Investigate developmental milestones, age of tooth eruption, school performance.Ask about maternal problems in pregnancy, complications with pregnancy or delivery, birth weight/length, and postnatal problems.Include parents’ and siblings’ heights, age of puberty, medical problems, and history of consanguinity or congenital anomalies.Maternal exposures: Alcohol, smoking and other toxins.Non-chromosomal: Russell-Silver, Noonan syndrome.Chromosomal: Down Syndrome, Turner’s Syndrome.Causes: Chromosomal abnormalities or syndromes.Normal or decreased Weight/Height ratio.There are 4 patterns of short stature due to pathological conditions: Final height consistent with mid-parental height.Period of severe growth deceleration lasting 1-3 yrs and may begin at less than 2 years.Normal birth history and growth for first few months.Delayed growth in one parent but average final stature.Absence of physical or psychological disease.Bone age consistent with chronological age.Normal birth history and gestational weight. ![]() There are 2 sub-classifications of short stature due to normal variation: Presentation (and Differential Diagnosis) Pathological conditions resulting in short stature include malnutrition or malabsorption, chronic diseases, skeletal or bone diseases, and endocrinopathies. ![]() Normal variations of slowed growth include constitutional delay and familial or genetic factors. Boys: (Dad’s height + Mom’s height + 13cm)/2.Girls: (Dad’s height + Mom’s height – 13cm)/2.A range 8.5 cm above or below this predicted height is considered within the 3rd to 97th percentile. For boys, 13 cm is added to his mother’s height, which is then averaged with his father’s height. For girls, 13 cm is subtracted from her father’s height, which is then averaged with her mother’s height. Finally, in the pubertal phase, there is a growth spurt of 8 to 14 cm per year, as a result of increasing growth hormone and gonadal steroid hormone secretion.Ī child has a final growth potential estimated using the mid-parental height, adjusted for the child’s gender. During the childhood phase, growth is at a relatively constant velocity at 5 to 7 cm per year, often with a slight slowing in late childhood. Total growth during this period is approximately 30 to 35 cm. During this time, intrauterine growth is offset as infants grow towards their genetic potential and may cross percentile lines. In the first two years of life, or infantile phase, growth is rapid, but decelerates. Height growth is a continuous, non-linear process with three phases: infantile, childhood, and pubertal. Short stature in a child must be fully investigated to distinguish between a normal variation and an underlying pathological condition. crosses percentile lines on a linear growth curve).Ī child’s growth is important because it is a strong indicator of his or her health. A growth pattern is abnormal if it shows slowed growth that deviates from a previous pattern or percentile (ie. The height growth pattern over a period of time is more important than a single measurement at one point in time. Short stature in a child is defined as a child 2 or more standard deviations below the mean height for children of that gender and chronological age.
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