Short and Tall Stature Children

Question 1

Catch-up or Catch-down Growth Phenomenon

Answer 1

In 1st 18mos of life, growth rate percentile shifts linearly until child reaches genetically determined growth channel or height percentile
Children with tall parents move up growth chart
Children with short parents move down growth chart

Question 2

Approaches to Height Measurement

Answer 2

Measure supine until 3 yo
Measure standing in children >3 yo
Standing height always < supine measurement
In premature children, height and wt adjustment for gestational age until 2 yo

Question 3

Weight Measurement

Answer 3

Just as important to graph as height
Malnutrition - most common cause of poor growth in children
Malnutrition can be dx’d in a child 2 yo or younger whose wt for length <5th percentile
2yo whose BMI is 95th percentile = overweight
BMI for age 85th-95th percentile - indicates risk for becoming overweight

Question 4

Estimated Adult Height Potential

Answer 4

Midparental Height = child’s projected height based on height of parents
Girls = father’s height minus 13cm (5in) averaged with mother’s height
Boys = mother’s height plus 13cm averaged with father’s height

Question 5

Arm Span Measurements

Answer 5

Arm span < height before puberty
Arm span > height after midpuberty
Scoliosis can lead to shortened vertebral growth and arm span disproportionate to height

Question 6

Short Stature

Answer 6

= height that is 2 SD below avg height for age and sex (2 SD below midparental height)

Question 7

Growth Velocity Disorder

Answer 7

abnormally slow growth rate, which may manifest as
height deceleration across two major percentile lines on
the growth chart

Question 8

Short Stature Eval - Hx

Answer 8

Maternal health habits during pregnancy
Duration of gestation
Birth wt and length
Onset and duration of catch-up or catch-down growth
Growth pattern and general nutrition
Detailed ROS

Question 9

Abnormal Growth Findings Suggesting Need for Referral

Answer 9

Height: growth less than the 3rd percentile or greater than the 95th percentile for height
Growth velocity: decreased or accelerated growth velocity for age (see Table 1 for normal growth velocities)
Genetic potential: projected height varies from midparental height by more than 5 cm (2 in)
Multiple syndromic or dysmorphic features: abnormal facies, midline defects, body disproportions
Bone age: advanced or delayed by more than two standard deviations

Question 10

Screening Tests

Answer 10

Complete blood count with differential: Evaluates for anemia, blood dyscrasia, and infections
Basic metabolic panel: Rules out renal disease and electrolyte abnormalities that could occur with Bartter syndrome, other renal or metabolic disorders, and diabetes insipidus
Liver function testing: Assesses metabolic or infectious disorders associated with liver dysfunction
Urinalysis and urine pH level: Assesses kidney function and rules out renal tubular acidosis
Erythrocyte sedimentation rate: Evaluates for chronic inflammatory states

Question 11

Tall Stature

Answer 11

= Height that is 2 SD above mean for age and sex
Most children whose height is >95th percentile are part of normal distribution curve
But tall stature/height acceleration my be 1st sign of serious underlying disease, ex. congenital adrenal hyperplasia

Question 12

Excessive Growth

Answer 12

= abnormally rapid growth velocity

Could manifest as height acceleration across two major percentile lines on the growth chart

Question 13

Tall Stature Hx

Answer 13

Maternal health habits during pregnancy
Duration of gestation
Birth wt and length
Onset and duration of catch-up or catch-down growth
Growth pattern and general nutrition
Detailed ROS
infants with macrosomia - hx of maternal gestational diabetes and family hx of dysmorphology should be explored

Question 14

Obesity

Answer 14

Most common cause of tall stature in children
Children who are obese usually have slightly advanced
pubertal status for age, modest overgrowth, and minimally advanced skeletal maturation.