June Week 3: Short Stature
Susan R, et al. A General Pediatric Approach to Evaluating a Short Child. Peds in Review. 2005;26;410-420
Parents are concerned because their 3yo boy is the same size as the 2 year olds in his playgroup. Both parents are healthy and there is no significant family history. Mom is 4’10” and Dad is 5’3”. They want to know whether he is short because they are short, or if there is something wrong.
1. How do you calculate mid-parental height and what is his?
2. What is the best indicator that the boy is following his genetic growth pattern?*
a. Bone age that is normal- accurate after 6 or 7 years of age
b. Height at the 3rd percentile for age- does not tell you growth velocity
c. Normal weight for height- non-specific; cannot make the diagnosis of FSS.
d. Steady linear growth a 3cm/year- too slow
e. Steady linear growth at 5cm/year
3. In a short child with normal growth velocity, what is the best test to compare Familial Short Stature with Constitutional Growth Delay? What are some key differences between the 2 conditions?
*PREP question (SA10 #74).
A 4 year old girl comes for her WCC and parents are concerned about her growth. She was at the 50th percentile for height and weight at birth but is now 25th percentile for weight and below the 5th percentile for height. Otherwise physical exam is normal. There is no family h/o short stature.*
1. What is the differential for deceleration of linear growth with relatively preserved weight (increased weight-to-height ratio)?
2. What are common features between these?
3. What is your initial work up for this child?
* “Laughing Your Way” page 61.