Evaluation of short stature
In the third part of our endocrinology series, H S Randeva and P M G Bouloux explain how to distinguish between normal variants of growth and growth disturbances caused by pathological processes
Short stature is the commonest reason for a child to be seen by a paediatric endocrinologist. Most children referred with short stature are normal. It is important to differentiate normal variants of growth from growth disturbances secondary to underlying pathology or disease processes, thereby preventing the child from being exposed to unnecessary investigations.
The fastest growth rate is achieved prenatally, birth size predominantly relating to maternal factors (for example, nutrition) than fetal factors. Several months after birth, maternal influences lessen and genetic factors become predominant. In the first year of life, growth velocity is most rapid (up to 22 cm/year) but declines during childhood, to around 5-7 cm per year in mid-childhood, decelerating further before puberty until the pubertal growth spurt (10-12 cm/year). The onset of puberty is her- alded by breast enlargement in girls and testicular enlargement in boys. Although the growth spurt in girls occurs earlier in the