Evaluation of Short and Tall Stature in Children

Short stature is defined as height that is more than 2 standard deviations below the mean height for age; tall stature is defined as height that is more than 2 standard deviations above the mean height for age. The initial evaluation of short and tall stature should include obtaining a comprehensive history, performing a physical examination, plotting serial height measurements on the Centers for Disease Control and Prevention or World Health Organization growth charts, calculating estimated adult height and comparing it with midparental height, determining bone age, and laboratory testing in select patients. The most common causes of short stature are constitutional delay of growth and puberty, familial short stature, and idiopathic short stature. Pathologic etiologies are less common and include nutritional deficiencies, systemic disease, growth hormone deficiencies, and genetic abnormalities. Common causes of tall stature include constitutional advancement of growth, familial tall stature, and obesity. Uncommon etiologies of tall stature include precocious puberty, Marfan syndrome, and Klinefelter syndrome. Referral to pediatric endocrinology is indicated in patients with idiopathic short stature for management of select genetic and metabolic conditions and for interventions to correct growth.