Peer Reviewed
Feature Article Paediatrics

Short stature in children: when is further evaluation and referral required?

Ann M. Maguire, Geoffrey Ambler, Maria E. Craig

Short stature is a common presenting problem to GPs. This article outlines the diagnostic possibilities, presents a practical approach for the initial evaluation and management and provides guidance on when referral to a specialist is recommended in children with short stature.

Key Points
  • Many children presenting with short stature are ‘normal variants’.
  • Monitoring growth velocity over a six- to 12-month period is a useful parameter in assessing growth and is often all that is required in children presenting with short stature.
  • Further evaluation and referral should be considered in children with severe short stature (≥3 standard deviations below the mean or <0.1 st percentile, which equates to approximately >6cm below the 3rd percentile).
  • Further evaluation and referral should also be considered in children with mild to moderate short stature (height below 2.3rd percentile) with any of the following:
      –  low growth velocity over six to 12 months (<25th percentile for bone age)
      –  clinical features suggesting a syndrome or disease
      –  family history that is out of keeping with short statue
      –  poor predicted adult height
      –  height within normal range but falling across percentiles
      –  disproportionate short stature.
  • Growth hormone therapy is available on the PBS for patients with growth hormone deficiency. It is also available for some nongrowth hormone deficient indications, such as severe nongrowth hormone deficient short stature (if also growing slowly), Turner syndrome, chronic renal failure and Prader-Willi syndrome. Specialist referral of the patient is recommended if growth hormone therapy is being considered.

    Picture credit: © Getty Images/Ryan McVay

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