The Short Child

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Abstract
1. Maria G. Vogiatzi, MD* 2. Kenneth C. Copeland, MD† 1. 2. *Instructor of Pediatrics, New York Hospital-Cornell Medical College, New York, NY. 3. 4. †Professor of Pediatrics, Baylor College of Medicine, Houston, TX. 1. Determination of height velocity is the most critical factor in evaluating the growth of a child. 2. A decreased height velocity after the third year of life indicates pathology unless proven otherwise. 3. Constitutional delay of growth and adolescence (CDGA) and familial short stature (FSS), the two most common entities associated with short stature, are characterized by deceleration of linear growth during the first 2 or 3 years of life. 4. Weight-for-height ratio may help distinguish “systemic” disorders (including gastrointestinal, renal, cardiopulmonary, and immunologic) from endocrinopathies. 5. Dysmorphic features are variable but important clues supportive of a diagnosis of genetic disorders. 6. Children who have congenital growth hormone (GH) deficiency often present in the newborn period with hypoglycemia in combination with prolonged hyperbilirubinemia. Growth represents a sentinel for the general health of a child. However, the distinction between normal and abnormal growth may be difficult to make at times. The purpose of this review is to highlight differences between growth patterns associated with normal variations and those associated with pathologic conditions. A method of categorizing growth patterns is used that is based principally on analyses of height velocity, weight for height, and abnormal physical features. Determination of height velocity is the single most critical factor in evaluating the growth of a child, and the simplest way to determine whether a height velocity is normal for age is to observe whether a height is “crossing” percentiles on the linear growth curve. Weight-for-height ratio may be helpful in distinguishing “systemic” disorders (including gastrointestinal, renal, cardiopulmonary, and immunologic) from endocrinopathies. The short child who has one of the “systemic” disorders typically is short and thin; the child who has an endocrinopathy usually is short and well-nourished or frankly obese. Dysmorphic features, disproportionate shortening, a history of intrauterine growth retardation (IUGR), and mental retardation are variable but important clues …
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