Normal growth patterns are the gold standard indicating health and well-being of children. Slow growth or short stature raises the possibility of an underlying pathological condition.
Though short stature in children beyond the first 2 years of life can be due to non pathological variants of growth, it is important to evaluate a short child systematically to detect pathological causes of growth failure (primary growth disorders, systemic disorders, endocrine disorders). Short stature can be the only presenting feature in a girl with Turner syndrome while some girls with Turner display subtle dysmorphic feature. Children born small for gestational age who do not experience catch up growthmay benefit from growth hormone therapy. Therefore, accurate measurement of growth parameters and carefully plotting them on appropriate growth chart serially should be done for all children for early detection of poor growth and for timely intervention. A decreasing height velocity SDS or height crossing 2 percentile lines in the height chart indicates growth failure and this may occur long before severe short stature become obvious.
Rate of linear growth changes during different phases of growth and variations occurs with differences in the onset of puberty. Available growth charts include the World Health Organization standards and Centers for Disease Control and Prevention charts. In a 2019 publication by Bradley S. Miller et al, it is reported that Tanner Staging Age Height charts may be useful to assess linear growth for US children with pubertal timing variations in clinical management and research setting.
Detailed personal, family, social history followed by a thorough physical examination is needed before planning for laboratory or radiological investigations. Family history with informations on longitudinal growth patterns, adult height and pubertal onset helps to detect certain familial conditions and helps differentiating variants of normal growth.
With the advancement in genetic testing (though still not that easily available locally), it may be considered in certain cases after getting a multidisciplinary input including a consult with the geneticist and endocrinologist. A good example can be seen in some healthy children with a diagnosis of familial short stature whom were found to have heterozygous variant in genes involved in growth plate development.
Early identification of abnormal growth patterns allows specialise care to be offered timely to the children to improve their final adult height besides treating the underlying conditions to improve overall clinical outcomes. 2 clinical short cases will be presented.
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