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- Short stature is height <2 standard deviations (SD) below mean or <3rd percentile for age and sex of the normal population.
- Growth failure defined as height <2 SD 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. True growth failure is typically pathologic and requires evaluation.
- Failure to thrive (FTT) is failure of appropriate weight gain (decreased weight to height ratio). May be accompanied by poor linear growth.
- Poor nutrition, systemic chronic illness, and psychosocial factors can contribute to 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 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 suppressed osteogenesis.