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Short stature

Definition

A child who has short stature is much shorter than children who are the same age and sex.

Your health care provider will go over your child's growth chart with you. A child with short stature's height is:

  • 2 standard deviations (SD) or more below the average height for children of the same sex and age
  • Below the 2.3rd percentile on the growth chart -- out of 1,000 boys (or girls) who were born on the same day, 977 of the children are taller than your son or daughter

Alternative Names

Idiopathic short stature; Non-growth hormone deficient short stature

Considerations

Your child's health care provider checks how your child is growing at regular checkups. The provider will:

  • Record your child's height and weight on a growth chart.
  • Monitor your child's growth rate over time. Ask the provider what percentile your child is for height and weight.
  • Compare your child's height and weight to other children of the same age and sex.
  • Talk with you if you are worried that your child is shorter than other children. If your child has short stature, this does not necessarily mean that something is wrong.

Causes

There are many reasons why your child has short stature.

Most of the time there is no medical cause for short stature.

  • Your child may be small for her age but is growing okay. She will probably start puberty later than her friends. Your child will most likely keep growing after most of her peers have stopped growing, and will probably be as tall as her parents. Health care providers call this "constitutional growth delay."
  • If one or both parents is short, your child will most likely also be short. Your child should get as tall as one of her parents.

Sometimes short stature may be a symptom of a medical condition, such as:

Bone or skeletal disorders, such as:

Chronic diseases, such as:

Genetic conditions, such as:

Other reasons include:

This list does not include every possible cause of short stature.

When to Contact a Medical Professional

If your child appears to be much shorter than most children his age, or if he seems to have stopped growing, call your health care provider.

What to Expect at Your Office Visit

The health care provider will perform a physical examination. The provider will measure your child's height, weight, and arm and leg lengths.

To figure out possible causes of your child's short stature, the provider will ask about your child's history.

If your child's short stature may be due to a medical condition, your child will need lab tests and x-rays.

Bone age x-rays are usually taken of the left wrist or hand. The provider looks at the x-ray to see if the size and shape of your child's bones have grown normally. If the bones have not grown as expected for your child's age, the provider will talk more about why your child may not be growing normally.

Your child may have other tests if another medical condition may be involved, including:

  • Complete blood count
  • Growth hormone stimulation
  • Thyroid function tests
  • Insulin growth factor-1 (IGF-1) levels
  • Blood tests to look for liver, kidney, thyroid, immune system, and other medical problems

Your provider keeps records of your child's height and weight. Keep your own records, too. Bring these records to your provider's attention if the growth seems slow or your child seems small.

TREATMENT

Your child's short stature may affect her self-esteem.

  • Check in with your child about relationships with friends and classmates. Kids tease each other about many things, including height.
  • Give your child emotional support.
  • Help family, friends, and teachers emphasize your child's skills and strengths.

TREATMENT WITH GROWTH HORMONE INJECTIONS

If your child has no or low levels of growth hormone, your provider may talk about treatment with growth hormone injections.

Growth hormone injections are also used to treat children with:

  • Chronic kidney failure
  • Idiopathic short stature (ISS -- short stature of unknown cause)
  • Prader-Willi syndrome
  • Turner syndrome

Most children have normal growth hormone levels and will not need growth hormone injections. Your health care provider may talk about growth hormone injections when:

  • The growth curve shows that the child will be a very short adult. Using growth hormone will usually increase the child's final height by 1 1/2 to 2 1/2 inches (2 to 4 cm).
  • The child is having extreme trouble with self-esteem and fitting in due to being short (although there is no scientific evidence that growth hormone treatment will improve self-esteem).
  • It is important to realize that this treatment will not lead to big changes in adult height. Also, the child will need an expensive shot every day for many years. 

If your child is a boy with short stature and delayed puberty, your health care provider may talk about using testosterone injections to jump start growth. But this is not likely to increase adult height.

References

Cohen P, Rogol AD, Deal CL, et al. Wit JM: 2007 ISS Consensus Workshop participants. Consensus statement on the diagnosis and treatment of children with idiopathic short stature: a summary of the Growth Hormone Research Society, the Lawson Wilkins Pediatric Endocrine Society, and the European Society for Paediatric Endocrinology Workshop. J Clin Endocrinol Metab. 2008;93:4210-4217.

Collett-Solberg PF, Misra M. Drug and Therapeutics Committee of the Lawson Wilkins Pediatric Endocrine Society. The role of recombinant human insulin-like growth factor-1 in treating children with short stature. J Clin Endocrinol Metab. 2008;93:10-18.

Cooke DW, Divall SA, Radovick S. Normal and aberrant growth. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology. 12th ed. Philadelphia, PA: Elsevier Saunders; 2011;chap 24.

Sisley S, Trujillo MV, Khoury J, Backeljauw P. Low incidence of pathology detection and high cost of screening in the evaluation of symptomatic short children. J Pediatr. 2013;163:1045.

van Gool SA, Kamp GA, Odink RJ, et al. High-dose GH treatment limited to the prepubertal period in young children with idiopathic short stature does not increase adult height. Eur J Endocrinol. 2010;162:653-60.


Review Date: 12/12/2014
Reviewed By: Kimberly G. Lee, MD, MSc, IBCLC, Associate Professor of Pediatrics, Division of Neonatology, Medical University of South Carolina, Charleston, SC. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
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