Description
In pediatrics, the approach to short stature entails a meticulous evaluation encompassing a thorough medical history, growth chart analysis, and physical examination. Assessing growth velocity, bone age, and considering familial height patterns aid in distinguishing between constitutional growth delay and underlying pathologies. Hormonal assays, imaging studies, and genetic assessments are employed for targeted diagnoses, encompassing endocrine, genetic, or nutritional origins. Tailored interventions, ranging from growth hormone therapy to nutritional optimization, are implemented based on the identified etiology. Regular follow-ups and collaboration among pediatricians, endocrinologists, and genetic specialists are pivotal for a comprehensive and effective management strategy, aiming to optimize the child's growth potential and overall health.
Summary Listen
- Growth monitoring in children is crucial as a barometer of well-being, preventative care, and identification of growth, nutritional, and systemic disorders. Growth charts are essential tools, requiring proper selection, accurate plotting of weight, height, and BMI, and correct interpretation, using revised IAP charts (AP 2015) for children aged 5-18 years and WHO charts for those aged 0-5 years.
- Growth charts are percentile curves derived from population-based studies, with seven centile lines (3rd, 10th, 25th, 50th, 75th, 90th, and 97th) where the 50th represents the population mean. Height should be measured using an infantometer for children up to two years and a stadiometer thereafter, ensuring correct posture, and growth is plotted with a dot, not a cross.
- Growth velocity, the rate of growth over time, is more important than height at a specific point, requiring consideration of previous measurements. AP charts allow for easy calculation of mid-parental height, providing a target height range (+/- 6cm) that is important for interpretation.
- Short stature is defined as height less than -2 standard deviations or below the 3rd centile, height more than 1.5 standard deviations below the mid-parental height, or growth velocity less than the 25th percentile or crossing two major centiles. Upper segment to lower segment ratio helps determine proportionality of short stature; shorter legs suggest skeletal dysplasia and a shorter spine suggest metabolic/storage disorders.
- Detailed history-taking is critical, including duration of growth failure, systemic illnesses, dietary intake, birth weight, developmental history, and family history. Accurate measurement of height, weight, head circumference, upper/lower segment ratio, and Tanner staging, combined with assessment for dysmorphic features are key aspects of the physical examination.
- Bone age assessment complements growth assessment, using methods like the GP atlas or Tanner-Whitehouse, although apps like Bone Expert can assist. Distinguishing between familial short stature and constitutional delay in growth and puberty involves considering family history, height velocity, pubertal development, and bone age.
- Investigations include a complete blood count, ESR, smear, urine analysis, renal and liver function tests, electrolytes, random blood sugar, free T4, TSH, and X-ray of the left wrist and hand to determine bone age. Second-line tests include karyotype (especially in girls), growth hormone stimulation tests, MRI brain (if growth hormone deficiency is proven), and IGF-1/IGFB3 measurement (especially in younger children).
- Management involves counseling, dietary advice, correcting underlying malnutrition, limb lengthening procedures (in skeletal dysplasia), treating underlying hypothyroidism with levothyroxine, and growth hormone therapy. Early identification and appropriate interventions are critical for optimizing outcomes.
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About the Speakers
Dr Dhanya Soodhana
Senior Specialist, Pediatric and Adolescent Endocrinology, Aster MIMS, Calicut, Kerala
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