Definition

Short stature is a height that is smaller than the average height for a person's age, sex, and racial group. It is specifically height that is in the third percentile.

Short stature is generally broken down into three subgroups:.

• Familial short stature—parents are short
• Constitutional delay and development—child is small for age but growing at normal rate, will reach an adult height similar to parents
• Caused by chronic disease—such as malnutrition, genetic disorders, heart problems, or growth hormone deficiency are just a few that can affect growth treatment will be needed to reach full height potential

Expected Growth (Shadow) and Short Stature

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Contact a doctor if you notice a significant decrease in your child's growth rate or if your child has stopped growing.

Causes

Familial and constitutional delay are due to the child's genetic make-up. If both parents are shorter than average, the child will most likely have short stature. The child may also have delayed puberty. This may cause temporary short stature, but normal height will eventually be reached.

Medical conditions that may contribute to short stature, include:

• Malnourishment—most common cause of growth failure and is generally associated with poverty
• Genetic disorders such as skeletal dysplasias, Turner syndrome, Down’s syndrome, Silver Russell syndrome
• Endocrine disorders such as hypothyroidism or growth hormone deficiency
• Congenital heart disease
• Kidney diseases
• Liver failure
• Sickle cell anemia —a blood disorder
• Disorders of the stomach or intestines such as inflammatory bowel disease
• Lung conditions such as cystic fibrosis, severe asthma, chronic obstructive pulmonary disease
• Use of SSRI’s medications (may be used to treat attention deficit disorder or obsesive compulsive disorder)

Risk Factors

Factors that may increase the risk of short stature include:

• Having family members with short stature
• Poor diet
• Certain diseases and drugs taken by a pregnant woman will increase risk to the newborn child

Symptoms

Symptoms vary depending on the type of condition. Children with familial short stature do not have any disease-related symptoms. They will often reach a height similar to that of their parents.

Children who have delayed puberty, late bloomers, will often have a close relative with the same delay. These children will also eventually catch up to their peers in height.

Symptoms that may indicate a medical condition include:

• Stopped or dramatically slowed growth (below the third percentile as determined by your doctor)
• Weight loss or gain (more than five pounds in a month)
• Poor nutrition
• Loss of appetite
• Chronic abdominal pain and diarrhea
• Persistent fever
• Chronic headaches and/or vomiting
• Delayed puberty (no spotting by age 15 for a girl or no enlargement of the testes by age 14-15 for a boy)
• Obstructed sleep apnea

Diagnosis

Your child’s doctor will ask about symptoms and medical history. A physical exam will be done. Your child's height, weight, and body proportion will be measured. The skull and facial features will also be examined.

Some tests may be done to diagnose or exclude contributing conditions. These tests may include:

• Bone age: an x-ray to determine the chronological age of your child’s bones
• Blood tests:
  • To check for hypothyroidism–low levels of thyroid hormone
  • To check growth hormone levels–an important factor in growth
  • To check for signs of conditions that may cause short stature like respiratory problems, malnutrition, and liver disease
• A complete blood count to check for blood diseases
• A genetic exam to detect chromosomal abnormalities and to exclude Turner syndrome (a common cause of short stature in girls)
• Urinalysis—examination of urine to look for conditions like kidney disease

Treatment

Children with familial short stature do not require treatment. For others, treatment will focus on the cause of short stature. Treatments can vary greatly but may include medication or nutritional changes.

Prevention

Short stature cannot be prevented in children who have a familial short stature or those who have a chronic disease. In some cases, you can minimize your child’s risk of developing short stature by making sure the child eats a nutritious diet.

Parents can minimize the risk of short stature in their children by eating a nutritious diet during pregnancy.