A General Pediatric Approach to Evaluating a Short Child

1. Susan R. Rose, MD* 2. Maria G. Vogiatzi, MD† 3. Kenneth C. Copeland, MD‡ 1. *Professor of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio 2. †Assistant Professor of Pediatrics, New York Presbyterian Hospital/Weill College of Cornell University, New York, NY 3. ‡Professor of Pediatrics, University of Oklahoma Health Science Center, Oklahoma City, Okla After completing this article, readers should be able to: 1. Describe the most critical test for evaluating the growth of a child. 2. Discuss the implications of decreased growth velocity after age 3 years. 3. Name the two most common normal variations resulting in short stature during childhood. 4. Characterize the growth velocities of children who have constitutional delay of growth and adolescence or familial short stature during the first 2 or 3 years after birth. 5. Recognize what a low weight-for-height ratio suggests. 6. List clues suggestive of syndromic or genetic disorders. 7. Describe how children who have congenital growth hormone deficiency may present in the newborn period. Achild’s growth pattern is a strong indicator of his or her general health. However, it may be difficult to distinguish between normal and abnormal growth. The purpose of this review is to highlight differences between growth patterns seen in normal variations of growth and those seen in pathologic conditions. In this review, growth patterns associated with normal variations or pathologic conditions are presented in the context of growth velocity, weight-for-height, and dysmorphic physical features. The most critical factor in evaluating the growth of a child is determining growth velocity (regardless of the absolute height). The simplest method of identifying whether a growth velocity is normal for age is to observe whether the child’s height pattern is “crossing” percentile lines on a linear growth curve. (The most up-to-date growth curves can be found on the Web site of the Centers for Disease Control and Prevention at www.cdc.gov/growthcharts .) Accurate height measurements performed at 6-month intervals and plotted to the year and month of age on the growth curve are an inexpensive means of identifying whether growth velocity is normal. Still more precise determinations of growth rate can be determined by using growth velocity charts. In addition to growth velocity, …