Short stature is a general term for those whose height is substantially below average compared to the height of their peers. Children with short stature have a height that falls below the third percentile on a growth chart. Your pediatrician uses growth charts to compare your child’s height to an average growth pattern for a child of their age and sex.

Each line on the chart indicates a certain percentage of the population that would be that particular height at a particular age. A boy with a height that is plotted on the 25th percentile line, for example, indicates that approximately 25 out of 100 boys his age are shorter than him. Most children do not follow these growth patterns exactly, but their growth over time should be roughly parallel to the established pattern lines.

Short stature may seem harmless, but can actually indicate an underlying medical problem. When this is the case, many children can receive appropriate treatment and continue to grow to a normal height. For others, short stature may be permanent.

How is Abnormal Growth Determined?

Your pediatrician will take many things into account when assessing your child's growth pattern, especially the height of both parents. A child born to parents who are below average height is also likely to be below average in height. Your pediatrician will also consider your child’s rate of growth, or growth velocity.

If your child’s velocity slows, dropping them further and further down the growth curve, this may be a warning sign of an underlying medical condition which is affecting growth. This is one of many reasons it is important for your child to have regular check-ups with their pediatrician.

When to See a Doctor

Only your child’s doctor can determine whether their short stature is due to an underlying medical cause. In addition to going to the doctor, it is also possible for you to monitor your child’s height and overall health at home. While doing so, be alert for these warning signs:

• Significant height difference between your child and classmates who are the same age and gender
• Decrease in your child’s growth
• Year old clothing which still fits your child comfortably

Your child’s clothing, in particular, can be a great indicator of how fast they are growing. Typically, children grow two to three inches per year which means if clothing that is a year or more old still fits comfortably, your child may not be growing at an appropriate rate.

 If you notice any of these signs in your child, talk to your pediatrician. Early intervention could be crucial to helping your child overcome a delay in their growth.

What Causes Short Stature?

There are four major reasons a child may experience short stature: idiopathic stature, constitutional growth delay, genetics, or disease. Your pediatrician can help determine the cause and best course of action for treatment.

Idiopathic Short Stature

This simply means there is no identifiable cause for the short stature of your child, but they are healthy. It is unclear why this is sometimes the case for certain children. However, parents can rest easy knowing their child is healthy and not at risk for further complications.

Constitutional Growth Delay

Some children simply develop later than others, often referred to as “late bloomers.” Children with constitutional growth delay are small for their age and will likely enter puberty later than their peers. However, they’ll continue to grow after their friends and most others their age have stopped, catching up in growth by adulthood.

 IUGR / SGA

Children with intrauterine growth retardation (IUGR) who were born small for gestational age (SGA) with no catch-up growth during the first 2 years of life

Genetics

If one or both parents are short, even if not short statured, there’s a strong possibility that their child will also be short. If there are no underlying medical reasons why either parent is short, their child’s short stature is likely perfectly healthy.

 Malnutrition

Malnutrition or undernutrition is also associated with slow linear growth rate. Careful patients history information and food diary can help the dietitian assess the intake information and find out whether the child get enough macro and micro nutrient to support appropriate growth.

Disease

A number of diseases may result in a child’s unusually short stature. These diseases fall into several categories: chronic diseases, genetic conditions, endocrine diseases, and bone or skeletal diseases. Problems during pregnancy, and malnutrition of a child, can also affect height and lead to short stature. However, growth problems caused by malnutrition are uncommon in the United States. Here are some possible conditions which may lead to short stature in your child:

Chronic Diseases

1. Malabsorption -  This syndrome includes a number of disorders where the small intestine cannot absorb enough nutrients and fluids that it needs to. Most common disorders in this category are celiac disease and Inflammatory Bowel Disease.
2. Celiac Disease - An autoimmune disorder where the ingestion of gluten causes damage in the small intestine.
3. Inflammatory Bowel Disease - This is a cluster of intestinal disorders that can lead to the inflammation of the digestive tract.
4. Heart Disease - Either congenital heart defects, which are present since birth, or acquired heart diseases which cause heart failure.
5. Severe Lung Disease

 Genetic Disorders

Many genetic syndromes are associated with short stature.

1. Turner Syndrome - the most common genetic disorder which causes short stature in girls is Turner Syndrome. A chromosomal disorder in which a female is born with only one X chromosome. It is also known as Monosomy X.

1. Noonan Syndrome
2. Russell Silver Syndrome

Endocrine Diseases

1. Growth Hormone Deficiency - A growth hormone deficiency (GHD) occurs when a person's pituitary gland does not produce enough growth hormone. This is not a very common condition among children.

1. Hypothyroidism - The thyroid gland produces a hormone that controls how cells use energy, or metabolize. Hypothyroidism occurs when the body doesn't produce enough of this hormone.
2. Cushing Syndrome - due to Cushing disease (very rare) or secondary to chronic steroid treatment.

Bone Dysplasia

1. Achondroplasia -  Achondroplasia is a genetic mutation resulting in short limbs.

1. Rickets - Rickets is a disorder that can develop due to a lack of vitamin D, calcium, or phosphate causing a softening and weakening of bones in children.

How is the Cause of Short Stature Diagnosed?

In order to determine the cause of your child’s short stature, your pediatrician will measure your child’s height, weight and limb length in conjunction with certain medical tests. Your doctor will also ask about your family’s and child’s medical history.

You should be prepared to answer these questions thoroughly, including: 

• Does your family have a history of genetic conditions?
• Does your family have a history of endocrine, chronic or skeletal disease?
• When did puberty start for both parents?
• Were there any complications during your child’s birth or the pregnancy?
• Have you noticed any peculiarity in the patterns of your child’s growth?
• What does your child’s typical diet consist of?
• Are there any other notable symptoms present?
• Try and bring all information on height and weight of your child from his past.

 Your pediatrician may also choose to order additional medical tests in an effort to diagnose a particular medical condition if suspected.

These tests can include:

• X-ray of the growth plates in the left hand to check that your child’s growth corresponds to their age
• GHD screening
• Complete blood count to check for anemia or other  blood diseases
• DNA analysis to check for genetic diseases, specifically Turner syndrome in girls
• Blood work to check for thyroid, liver, kidney, celiac and other problems

If your pediatrician finds that your child does in fact have short stature, they can help you review treatment options and develop a plan of intervention that is appropriate for the determined cause.

Treatment Options & Outlook

The treatment for short stature depends on the specific cause in your child. Thyroid hormone replacement can be used to treat hypothyroidism while growth hormone injections can treat GHD and a number of other conditions, including Turner syndrome and chronic kidney failure.

Children diagnosed with GHD will typically grow to average height, or a height similar to their parents, if they receive treatment intervention prior to beginning puberty.

However, every case of short stature may not require treatment. For those children who are naturally short, no treatment is necessary. Even so, it may be challenging for your child if they encounter teasing from other children. As a parent, you can provide reassurance and emphasis on acceptance and loving of one’s body. 

Monitoring your child’s growth will help you be vigilant in looking for the signs of short stature. There is a lot to consider when thinking about your child’s height and it is best not to jump to conclusions.

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