Short Stature

Basics

Short stature is height 2 standard deviations (SD) or more below mean or <3rd percentile for age and sex of the normal population.
Growth failure is defined as height 2 SD or more, below midparental height (MPH), or height velocity (HV) <10th percentile for age resulting in downward crossing of height percentiles.
The majority of children with short stature are essentially healthy. Conversely, true growth failure is typically pathologic and requires evaluation.
Failure to thrive (FTT) is failure of appropriate weight gain (decreasing weight to height ratio); may be accompanied by poor linear growth

Poor nutrition, systemic chronic illness, certain medications, and psychosocial factors can all contribute to the clinical presentation of short stature or growth failure.
A family history of short stature or delayed growth and puberty are well-established risk factors for childhood short stature.

Adequate nutrition and weight gain play major roles in linear growth during childhood.
Throughout infancy and childhood, growth hormone (GH) and thyroid hormone exert major influences on normal growth.
Pulsatile GH release stimulates insulin-like growth factor 1 (IGF-1) secretion from the liver and other tissues to promote growth at growth plates.
The pubertal growth spurt is largely mediated by androgen and estrogen activity at the growth plate as well as enhanced GH release.
Chronic illnesses can cause growth failure.
Glucocorticoid excess inhibits growth through downregulation of the GH/IGF-1 axis and suppresses osteogenesis.
Although boys are more frequently referred for short stature, girls are more likely to have a pathologic reason for short stature.

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