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1. PRACTICAL APPROACH TO SHORT
STATURE
Dr Shantanu Gomase
DNB Resident 2nd year
J.L.N.H. & R.C. Bhilai

2. A child is considered to be short stature
when his/her height is below the 3rd
percentile on height chart for specific
population.
(IJPP 2011;13(4) ,396 – 401)

3. Causes of short stature
Physiological or Normal variant
a) Famalial
b) Constitutional
Pathological short stature
1) Undernutrition
2) Chronic systemic illness
Renal : RTA, CRF, Nephrotic syndrome
CVS & RS: CHD,CF , Asthama
GIT: Malabsorption, CLD
Chronic infections
3)Endocrine causes
GHD, hypothyroidism, cushing syndrome,precautious or delayed puberty
4)Psychosocial dwarfism
5)Children born SFD
6)Skeletal dysplasias i.e, Achondroplasia, Hypochondroplasia & ricket
7)Genetic syndrome: Turner, Down,Russell – silver syndrome
(OP GHAI 7th edi; 18)

4. APPROACH TO SHORT STATURE

5. Mid Parental Height (MPH)
(Mothers Ht + Fathers Ht)/ 2 + 6.5
(+6.5 for boys & - 6.5 for girls)
Target height = MPH + 6
(IJPP 2011;13(4) ,396)
Target height = MPH + 8
(INDIAN PEDIATRICS VOLUME 44__MARCH 17, 2007,189)

6. Which growth chart should be used?
• The growth charts compiled by Agarwal, et al. These charts
provide information on growth from birth to 18 years. In the
present circumstances, these charts remain best option for growth
monitoring in Indian children and are recommended for use by the
Growth Monitoring Guidelines Consensus Meeting of the IAP.
(INDIAN PEDIATRICS VOLUME 44__MARCH 17, 2007, 188)
• WHO recommends WHO growth charts should be used in all
childrens <5yrs .
(IJPP 2011;13(4) ,396)

7. 1)Confirm short stature by serial height monitering in
relation to target height
2) Height Velocity.
When height velocity observed over a period of
6mths or more falls below 25th percentile on velocity chart is
abnormal.

9. Etiological diagnosis is based on
detailed history, physical
examination and investigation

10. Clue from history
1)When does short stature starts?
By ICP model of Growth
Infancy: Malnutrition
Childhood: Hypothyroidism and GH deficeincy
Puberty: Disorders of puberty most comman cause is
constitutional delay of growth and puberty (CDGP)
2)H/o Delayed puberty in parents in CDGP
3)H/o poor dietary intake in undernutrition.
4) Social history.

11. • Others:
Clue to etiology of short stature
History Etiology
LBW SFA
Polyuria CRF, RTA
Diarrhoea, offensive stools Malabsorption
Neonatal GH deficiency
hypoglycaemia,jaundice,micropenis
Headache, Visual problems Pituitary/hypothalamic SOL
Lethargy, constipation, wt gain Hypothyroidism

12. Physical examination
• Anthropometry
1)Wt for age.
2)Ht for age.
3)Crown rump length/Sitting height
4)Sub ischial leg length
5)Wt for height
6)upper segment : lower segment
• Look for dysmorphic features.
• Head to toe examination.

13. What is disproportionate short stature?
When the disproportion between sub ischial leg
length and Sitting height is more than 2SD the child
is considered disproportionate.
(IJPP 2011;13(4) ,396)

15. ACHONDROPLASIA SPONDYLOEPIPHYSEAL DYSPLASIA

16. When to suspect disproportionate
shortening?
Disproportionate shortening of the limbs: If the upper limbs do
not reach the mid pelvis in infancy or the upper thigh after
infancy.
Disproportionate shortening of the trunk is indicated by a short
neck, small chest, and protuberant abdomen
( Nelson 19th edi)

17. • US:LS
At birth- 1.7:1
3yr- 1.3:1
6yr-1.1:1
10yr-0.9:1
Increased US:LS- ricket,achondroplasia,untreated
cong hypothyroidism
Decreased US:LS- Spondyloepiphyseal dysplasia
vertebral anamolies

18. Short child with
distinguishing feature
proportionate
disproportionate syndrome
Russell- silver
Short legs Short trunk
syndrome
Down,Turner,Noonan
Achondroplasia, Spondyloepiphyseal
Hypochondroplasia and MPS
Ricket

19. Short child looks normal
Normal growth velocity Low growth velocity
Chronic disease
LBW
Endocrine disease
Short parents
psychological
Growth delay

20. Clues on physical examination
Examination finding Etiology
Dysmorphology syndrome
Frontal bossing, depressed nasal bridge, GH deficiency
micropenis
Pallor CRF, chronic anaemia
Hypertension CRF
Goitre and coarse skin Hypothyroidism
obesity Cushing syndrome
 Tanner sexual maturity ratings should be done in all children
who present with short stature.

21. Investigations

22. Level 1 investigation for short stature
1) Complete blood count and ESR
2)Bone age
3)Urinanalysis including microscopy, osmolality, pH
4)Stool examination for Steatorrhea and occult blood (Malabsorption)
5)Blood- urea ,creatinine,venous gas(CRF, RTA)
Calcium, phosphate and ALP (RIcket)
Fasting glucose
Albumin and LFT (CLD)
Level 2 investigations
Serum T4 and TSH
Karyotyping
Level 3 investigations
Celiac serology
Growth hormone stimulation test, IGF-1 level

23. Bone Age
• It shoud be done in all patients of short stature.
• When bone age is retarded by 2 or more year is
abnormal
• BA<CA in all causes of short stature except
1)FSS (BA = CA)
2)Precocious puberty and obesity (BA > CA)
• BA markedly less than CA in Endocrine diseases and
marginally less than in other chronic diseases and
malnutrition.

24. • In children with skeletal dysplasias and
other disproportionate short stature Skeletal
Survey should be done.

25. Growth formulae
• A combination of chronological age(CA), Height age(HA),weight
age(WA)And bone age(BA) can help in reaching in many
childrens.
CA>HA>WA = Malnutrition/ Chronic disease
(Mild bone age retardation)
CA<HA<WA = Exogenous obesity
(BA mildly advanced)
CA<WA<HA = precocious puberty
(BA significantly advanced)
WA>CA>HA = Endocrine obesity
(BA significantly retarded)