Evaluating short stature in children

A child's growth reflects his or her general state of health. Growth deceleration therefore may result from processes that ultimately threaten much more than height and weight. Accurate height and weight measurements and routine plotting of growth data on standard growth charts are important elements of pediatric practice. A decrease in length of height percentiles may be physiologic in infancy and in puberty. However, in order to distinguish physiologic from pathologic growth deceleration, a careful history and physical examination needs to be obtained. Quite frequently, laboratory and radiographic studies are needed to distinguish with confidence between causes of slow growth in these phases of life. Such studies are always required to evaluate growth deceleration during childhood, because growth deceleration in this phase is virtually always the result of a pathological process. If constitutional growth delay is diagnosed, reassurance is often adequate treatment, though continued monitoring of growth and bone age is indicated. Growth deceleration due to other processes is often treatable. Delineation of the causes of poor growth is particularly important because these disease processes may produce other serious problems.