Investigation and Management of Short Stature
Paediatricians need to develop a strategy for assessing and managing the short child because it is a common reason for referral to paediatric services. Understanding what is normal is a key prerequisite to the appropriate assessment of the short child. Most pathological causes of short stature will be associated with clues in the history or on examination. Factors that should trigger a more detailed assessment of the short child include malaise, dysmorphic features, slow growth and small size with a normal weight centile. Establishing that the healthy short child is growing appropriately for their family size can be reassuring for the family and clinician and will facilitate discharge.
Only a minority of short children, which can be defined as a height less than 2 standard deviation score (SDS) below the mean (less than the 2nd centile), will be found to have an underlying pathology. A diagnosis can frequently be reached without the need for further investigation, and this article will focus on some of the key features that indicate that a child is well and can be discharged. It will also focus on some of the pointers towards underlying pathology and introduce a framework that can be used to ensure that the assessment and plan of investigation are comprehensive. The same framework can also be used to explain the rationale for the assessment and diagnosis to the family. A clinical case will illustrate how the described framework can be used.
Abstract and Introduction
Abstract
Paediatricians need to develop a strategy for assessing and managing the short child because it is a common reason for referral to paediatric services. Understanding what is normal is a key prerequisite to the appropriate assessment of the short child. Most pathological causes of short stature will be associated with clues in the history or on examination. Factors that should trigger a more detailed assessment of the short child include malaise, dysmorphic features, slow growth and small size with a normal weight centile. Establishing that the healthy short child is growing appropriately for their family size can be reassuring for the family and clinician and will facilitate discharge.
Introduction
Only a minority of short children, which can be defined as a height less than 2 standard deviation score (SDS) below the mean (less than the 2nd centile), will be found to have an underlying pathology. A diagnosis can frequently be reached without the need for further investigation, and this article will focus on some of the key features that indicate that a child is well and can be discharged. It will also focus on some of the pointers towards underlying pathology and introduce a framework that can be used to ensure that the assessment and plan of investigation are comprehensive. The same framework can also be used to explain the rationale for the assessment and diagnosis to the family. A clinical case will illustrate how the described framework can be used.
SHARE
