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Short stature

Your child has short stature if he or she is at less than the 5th percentile on the growth chart. This means that:

  • Your child is significantly shorter than children who are the same age and sex.
  • In a class of 20 children, 19 of the children will be taller than your child with short stature.

Alternative Names

Idiopathic short stature; Non-growth hormone deficient short stature

Considerations

Your health care provider checks how your child is growing at your child’s regular check ups.

Your child’s health care provider:

  • Records your child’s height and weight on a growth chart.
  • Monitors your child’s growth rate over time. Ask your health care provider what percentile your child is for height and for weight.
  • Compares your child’s height and weight to other children of the same age and sex.
  • Can talk to you if you are worried that your child is shorter than most or all of the children around them. If your child has short stature, this does not necessarily mean that there is something wrong.

Causes

There are many reasons that your child has short stature.

Most of the time there is no medical cause for short stature. Here is what may be going on.

  • Your child may be small for their age but they are growing okay. They will probably start puberty later than their friends. Your child will most likely continue to grow after most of their peers have stopped growing. Your child will most likely be as tall as the parents. Health providers call this Constitutional growth delay.
  • If one or both parents is short, your child will mostly likely also be short. Expect that your child will be as tall as one of the parents.

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

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

When to Contact a Health Professional

If your child appears to be much shorter than most children his or her age or if they seem 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. They will measure your child's height, weight, and arm and leg lengths.

To figure out possible causes for your child’s short stature, the health care provider will ask about your child’s history. They will ask:

  • About your family history
    • How tall are the parents and grandparents?
    • How tall are the brothers or sisters?
    • Are other relatives less-than-average height?
    • Have any family members been diagnosed with a disorder that can cause short stature?
    • At what age did the parents start puberty?
  • About your child's history
    • What was the child's birth like?
    • How is the child's diet?
    • Has the child begun to show signs of puberty?
    • At what age did puberty signs begin?
    • Has the child always been on the small side of the growth charts?
    • Was the child growing normally and then the rate of growth began to slow?
    • What other symptoms are present?
    • Is the child's short stature affecting their self-esteem or causing any problems at school or with friends?

If your child’s short stature seems related to a medical condition, your child will need some lab tests and x-rays.

  • A bone age x-ray. X-rays are usually taken of the left wrist or hand.
  • Your health care 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, your health care provider will talk more about why your child may not be growing normally.
  • Girls with short stature may have a genetic test done to check for certain diseases such as Turner syndrome.

Your child may have other tests done as well. Some of these tests may be:

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

Your health care provider keeps records of your child’s height and weight. Keep your own records as well. Bring these records to your health care provider's attention if the growth seems slow or your child seems small.

TREATMENT

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

  • Check in with your child to check if classmates and friends tease them.
  • Give your child emotional support.
  • Help family, friends, and teachers emphasize your child's skills and strengths.

TREATING WITH GROWTH HORMONE INJECTIONS

If your child has no or low levels of growth hormone, your health care provider will talk about treatment with growth hormone injections. See: Growth hormone deficiency

Growth hormone injections are also used to treat children with Turner syndrome, Prader-Willi syndrome , chronic kidney failure, or idiopathic short stature (ISS).

Most children who have normal growth hormone levels 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 2 - 3 inches.
  • The child was born small for gestational age

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.

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.

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 Apr;162(4):653-60. Epub 2010 Jan 28.

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.

Updated: 8/22/2013

Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.


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