Short stature

Definition

Short stature refers to any person who is significantly below the average height for a person of the same age and sex.

The term often refers to children or adolescents who are significantly below the average height of their peers.

Alternative Names

Idiopathic short stature; Non-growth hormone deficient short stature

Considerations

A growth chart is used to compare a child's current height and how fast he or she is growing to other children of the same age and gender (male or female). A measurement called standard deviation (SD) is used. If a child's height is more than 2 SD's below the average height, the child is thought to have short stature.

Many parents become worried if their children are shorter than most or all of the children around them. However, short stature is not necessarily a symptom or sign of a health problem. Two relatively short but healthy parents may have an entirely healthy child who is in the shortest 5%.

On the other hand, short stature may be a symptom caused by a medical condition. Because many of these conditions are treatable, the person should be examined by a health care provider. The rate of growth over time is important in determining the cause.

Common Causes

Short stature may be due to a number of medical conditions or problems, including:

• Growth hormone deficiency
• Chronic diseases such as congenital heart disease, kidney diseases, asthma, sickle cell anemia, thalassemia, juvenile rheumatoid arthritis, inflammatory bowel disease, celiac disease, Cushing's disease, hypothyroidism, and diabetes
• Genetic conditions such as Down syndrome, Turner syndrome, Williams syndrome, Russell-Silver syndrome, and Noonan syndrome
• Bone or skeletal disorders such as rickets or achondroplasia
• Problems related to pregnancy, such as infections of the fetus before birth, poor growth of a baby while in the womb (intrauterine growth restriction), or born small for gestational age
• Panhypopituitarism
• Delayed puberty (causes temporary short stature, but children eventually grow to normal height)
• Precocious puberty
• Malnutrition

Short stature that has no medical cause (idiopathic short stature) can be due to:

• Family history of short stature (children are short but are expected to reach the height of one or both parents)
• Constitutional growth delay (normal growth until close to 12 months of age that slows afterward, puberty is delayed, adult height will eventually be in the expected range calculated from the parents' height)

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

Call your health care provider if

All children should have their growth and development monitored on a regular basis.

If your child appears to be much shorter than most children his or her age (or if the growth rate has decreased or stopped), call your health care provider.

What to expect at your health care provider's office

The health care provider will perform a physical examination. The child's height, weight, and arm and leg lengths will be measured. If the short stature appears to be a sign of some medical condition, further tests, including laboratory studies and x-rays, may be needed.

To learn more about possible causes, the health care provider will ask questions, such as:

• 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?
• 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 self-image or causing any problems at school or with friends?

A bone age x-ray is often done. X-rays are usually made of the left wrist or hand. Normally, the size and shape of bones change as a person matures. These changes can be seen on an x-ray and usually follow a pattern as a child grows older. Certain causes of short stature may be present if the bones have not changed or matured as expected for the child's age.

Girls with short stature may have a karyotype done to check for certain genetic diseases, such as Turner syndrome.

Other tests may include:

• Complete blood count
• Other blood tests to look for liver, kidney, thyroid, and other medical problems
• Insulin growth factor-1 (IGF-1) levels may be done for some children
• Growth hormone stimulation test may be done for some children

Although your health care provider keeps records of height and weight from routine examinations, you may find it helpful to keep your own records. You may want to bring these records to your health care provider's attention if the growth seems slow or the child seems small.

TREATMENT

Children of short stature who are found to have a lack of growth hormone in their body will usually be treated with growth hormone injections.

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

Many children with short stature of unknown cause do not need growth hormone injections. Children who are more likely to receive growth hormone injections are:

• Those who are greater than 2.25 - 2.5 SD below the average for their age and gender, or in the shortest 1.2% of children
• Those who were born small for gestational age

Some boys with short stature who also have delayed puberty may receive certain medicines containing the male hormone, testosterone.

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.

Parks JS, Feiner EL. Hypopituitarism. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa:Saunders Elsevier;2007:chap 558.

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.