When to Worry

  • Poor height velocity associated with severe headaches and/or blurry vision may be a brain tumor.
  • If a child is short and in puberty, this may increase the urgency of referral.
  • Short stature is more concerning if a child has a predicted height that is more than 4 inches shorter than expected for

Facts to Remember

  • Constitutional delay is the MOST common cause of short stature.
  • FDA criteria for growth hormone treatment in idiopathic short stature is a predicted adult height of less than 4’11” for girls or 5’4” for boys
  • Random growth hormone levels are NOT useful, please measure IGF-I and IGF-BP3 instead.
  • If the bone age shows fused growth plates > 14 in girls or > 16 in boys, then NO Endocrine referral is needed. There are NO treatment options to increase height once growth plates are fused.
  • Consider genetics referral if dysmorphic features are present.
  • Midparental target height (MPTH) equation is DIFFERENT for boys and girls.
    • MPTH(boys) = [(mom’s height + 5 in) + (dad’s height)] ÷ 2
    • MPTH(girls) = [(mom’s height) + (dad’s height – 5 in)] ÷ 2
    • MPTH is the average genetic target but normal children can be 2 to 4 inches shorter or taller than their target.
  • Key to evaluation of growth requires comparison of weight and length/ height curves.
  • If weight is decreasing more than length/ height, refer to gastroenterology PRIOR to Endocrinology.
  • IGF-I (Insulin like growth factor-I) levels will often be low in patients with low weight and may NOT be indicative of growth hormone deficiency.