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Identification of a child with short stature
1Department of Pediatric Medicine, Bai Jerbai Wadia Hospital for Children, Parel, Bombay.
Insights
The Indian Council of Medical Research (ICMR) height standards are more effective than Tanner
Area of Science:
- Pediatrics
- Endocrinology
- Growth Assessment
Background:
- Accurate assessment of short stature is crucial for timely diagnosis and intervention.
- Existing growth charts, like Tanner's, may not fully represent diverse populations.
- The Indian Council of Medical Research (ICMR) has developed its own height percentile standards.
Purpose of the Study:
- To compare the utility of ICMR height standards versus Tanner's standards in evaluating children with short stature.
- To assess the diagnostic yield of each standard in identifying endocrine causes of short stature.
- To determine the suitability of ICMR standards for lower socio-economic groups.
Main Methods:
- Initial survey of 500 new outpatient cases to assess heights using both ICMR and Tanner's standards.
- Detailed evaluation of 200 children below Tanner's 3rd percentile for short stature.
- Analysis of causes of short stature, including endocrine and normal variant short stature.
- Correlation of child's height with mid-parental height.
Main Results:
- Only 10% of initial cases fell below ICMR's 5th percentile, compared to 32% below Tanner's 3rd percentile.
- Of 200 children below Tanner's 3rd percentile, 66% were also below ICMR's 5th percentile.
- Endocrine causes accounted for 56.8% of short stature below ICMR's 5th percentile.
- Normal variant short stature was the primary diagnosis (67.8%) in children between ICMR's 5th and Tanner's 3rd percentiles.
- Correlation with mid-parental height was significantly higher in the group between the standards (90.4%) versus below ICMR's 5th percentile (16.6%).
Conclusions:
- ICMR height standards appear more sensitive in identifying children requiring further investigation for short stature, particularly from lower socio-economic backgrounds.
- Tanner's standards may overestimate the prevalence of short stature in certain populations.
- ICMR standards may better differentiate between pathological short stature and normal variant short stature.
Abstract:
The objective of this study was to determine the utility of Indian Council of Medical Research's (ICMR) height percentile standards in comparison to Tanner's, in the evaluation of children with short stature. The study consisted of an initial survey of the heights of 500 consecutive new cases brought to the Out Patient Department. The heights were assessed by both ICMR and Tanner's standards. Only 10% were below the 5th percentile of ICMR standards while as many as 32% were below the 3rd percentile of Tanner's standards. Two hundred children who were referred to the endocrine clinic primarily for short stature and who were below the 3rd percentile of Tanner's standards were then evaluated. Of these 200 short children 132 (66%) were also below the 5th percentile of ICMR standards. The major causes of short stature in those below the 5th percentile of ICMR standards were endocrine (56.8%). In the group between the 5th percentile of ICMR standards and 3rd percentile of Tanner standards the major cause of growth retardation was normal variant short stature (67.8% of cases in this group). Correlation of the child's height with the mid-parental height was seen in 90.4% in this group but in only 16.6% of those below the 5th percentile of ICMR standards. The ICMR standards may, therefore, be more suitable than Tanner's standards for the identification of a short child from the lower socio-economic groups.