Synopsis
Distinguish healthy familial or maturational short stature from nutritional, systemic, endocrine, genetic and skeletal disease using accurate growth velocity, genetic target, proportion, focused investigation and timely specialist management.
- Short stature usually means height below roughly the 2nd centile or 2 standard deviations, but trajectory and genetic target determine clinical significance.
- First-line assessment is repeat calibrated height plotted serially, with growth velocity, weight and BMI trajectory and measured parental heights.
- Familial short stature has short parents, height compatible with target, normal velocity and bone age close to chronological age.
Key red flags
Falling height centiles or low height velocity is more concerning than a stable low centile and requires confirmation with serial accurate measurements.
Investigation priorities
Distinguish stable short stature from active growth failure.
Determine whether growth is compatible with genetic potential.
Management branches
A child appears short or has a low recorded height.
- Repeat height with calibrated technique, retrieve previous data and plot weight, height and BMI on the correct chart.
- Calculate velocity from reliable measurements and obtain measured parental heights and puberty history.
Key medicines
Somatropin subcutaneous injectionSpecialist dosing is indication specific: a common paediatric growth-hormone-deficiency regimen is 23–39 micrograms/kg once daily subcutaneously, usually in the evening; Turner syndrome, chronic renal insufficiency and some other indications use higher licensed ranges. Use the selected product's BNFC regimen and do not exceed its indication-specific maximum.