📊 Definitions
• Short stature: height >2 SD below mean for age
• Growth velocity (deceleration) more concerning than absolute height
• Mid-parental height target: boys = (maternal+13 + paternal)/2; girls = (paternal-13 + maternal)/2. Target range = mid-parental ± 8.5 cm (3rd-97th percentile)
🩺 Normal Variants (Most Common)
• Familial short stature: normal growth velocity, bone age = chronological age, family history short stature
• Constitutional delay of growth and adolescence (CDGA): delayed bone age = height age, delayed puberty, family history of delayed puberty (usually father), normal final adult height
⚠️ Pathologic Causes – Red Flags
• Growth hormone deficiency: decelerating growth, delayed bone age, low IGF-1/IGFBP3, ± hypoglycemia, micropenis, midline defects
• Hypothyroidism: slow growth, delayed bone age, weight gain, fatigue, constipation, bradycardia
• Cushing syndrome: slow growth, weight gain (central obesity), moon facies, striae, hypertension
• Turner syndrome: short stature (karyotype 45,XO), webbed neck, shield chest, cubitus valgus, normal intelligence
📋 Weight-for-Height Pattern
• Weight < height → chronic illness, malnutrition, malabsorption (celiac, CF, IBD)
• Weight > height → endocrine (GH deficiency, Cushing, hypothyroidism), genetic syndromes
• Psychosocial dwarfism: emotional deprivation → functional hypopituitarism, catch-up growth after removal from environment
📌 Decision strategy: Normal growth velocity + appropriate weight = likely normal variant. Decelerating growth velocity → pathologic. Weight disproportional to height guides differential. Bone age is essential.