Short Stature

Children with growth concerns are among the most common presentations in pediatric endocrinology clinics, accounting for up to 50% of new visits. To understand short stature, we must first learn the basics of normal growth. Normal growth is a process in which a single cell develops into a fully grown adult. The growth rate decelerates from the embryonic stage to adulthood, except during puberty. Most adults fall within a narrow range of stature, typically between 1.5 to 2 meters. Variations in height among children are largely determined by a set of genes inherited from their parents. These genes influence stature distribution within the normal range for nearly 95% of the population, with variation generally being benign. (Source: International Clinical Practice Guidelines for Endocrine and Growth Disorders, 2013-2016) Short stature is defined as a height more than 2 standard deviations (SDs) below the mean for age, sex, and population, typically corresponding to the 2.3rd percentile, though many texts use the 3rd percentile as the cutoff. Short stature can be assessed using various anthropometric instruments. The condition may be physiological, with no abnormalities other than stature (polygenic short stature), or pathological, resulting from systemic illnesses, nutritional deficiencies, psychosocial factors, hormonal imbalances, genetic disorders, or musculoskeletal pathologies. A subset of infants born small for gestational age (SGA) may be at risk of persistent short stature. A careful evaluation of short stature is essential to avoid over-treatment of physiological conditions while addressing pathological causes that could lead to significant health issues. Short stature has both physical and psychosocial implications, as height is an important parameter in societal and certain job standards. Management focuses on treating the underlying cause and addressing psychosocial distress.