Growth disorders

R62

DESCRIPTION

Pathological growth failure may be suspected if a child is short relative to his/her peers, his/her parents and possibly disproportionate to his/her weight. It is confirmed by a reduced growth velocity. This could be due to endocrine causes, chronic or bone disease or dysmorphic syndromes.

Idiopathic short stature may be due to constitutional delay in growth and puberty or familial short stature. Constitutional delay in growth is defined by short stature with a disproportionately short trunk and significantly delayed a bone age relative to chronological age. Familial short stature is determined by genetic potential and a bone age equivalent to chronological age. Both have a normal growth velocity.

DIAGNOSTIC CRITERIA

  • Measure and plot child’s height and weight on growth charts. Routine monitoring of height and weight for growth assists in timely diagnosis and treatment, and thus ensures maximum benefit.
  • A child is regarded as short if his/her height for age z-score is below –2 for gender.
  • To further evaluate short stature, assess parental height. Target height:
    • for a boy = (father’s height + (mother‘s height + 13 cm)) ÷ 2
    • for a girl = ((father’s height – 13 cm) + mother‘s height) ÷ 2
  • If the child’s predicted final height is > 10 cm below the target height, monitor growth velocity over 6 months to 1 year.
  • If the child’s height for age z-score is below –3, refer immediately.
  • Growth failure occurs when the child’s height deviates further from z-score of –2 over a period of 1 year or the growth velocity is below 25ᵗʰ percentile for gender and age.

GENERAL AND SUPPORTIVE MEASURES

  • Identify and manage non-endocrine causes of stunted growth, e.g.:
    • intra-uterine growth retardation,
    • chronic disease,
    • psychosocial deprivation,
    • skeletal dysplasia and other dysmorphic syndromes.

REFERRAL

  • Height for age z-score below –3.
  • Height 10 cm or more below target height.
  • Growth failure (height deviates further from z-score of –2 over a period of 1 year) or the growth velocity is below 25ᵗʰ percentile for gender and age.
  • Suspected endocrine causes as suggested by a child who is short with a normal or high BMI.
  • Dysmorphic child with unidentified syndrome.
  • Untreated chronic disease.