SupplementEtiologies and Early Diagnosis of Short Stature and Growth Failure in Children and Adolescents
Section snippets
How to Measure Growth
Key evaluations used to determine growth in children over time include measurements of length or height, weight, and head circumference.1, 3 Determination of the circumference of the waist, hips, and neck and measurement of skin folds may provide additional information on growth in selected children.
Length is usually the measurement of choice in children aged <2 years, and height is the standard measurement for children aged >3 years.3 Between 2 and 3 years of age, both measurements often are
Monitoring Growth in Infants, Children, and Adolescents
“Normal” growth can be defined as a Gaussian phenomenon.4 Values for continuous variables, such as height and weight, are distributed along a bell-shaped curve, also known in statistical terms as the normal distribution (a graphical representation of normal distribution can be found in an article by Rogol4). The total area under the curve includes 100% of the analyzed population values, which are distributed to the left (eg, children with shorter stature compared with the mean) or to the right
Differentiating between Variants of Normal Growth and Pathological Short Stature
Growth failure may be detected during a routine well-child visit or on presentation with signs or symptoms of an acute or chronic illness, which may or may not be related to the child's current growth pattern. Clinical suspicion of growth impairment should prompt a review of the child's medical, family, and social histories, as well as a review of systems. Particular attention should be given to the series of issues outlined in Table I. A careful patient history may reveal abnormal growth in
Further Evaluation and Referral to a Pediatric Subspecialist
Although genetic syndromes associated with pathological stature are not very common (see the incidence data in the Table I, Table II, Table III, Table IV, Table V, Table VI, Table VII, Table VIII, Table IX, Table X, Table XI, Table XII, Table XIII, Table XIV, Table XV, Table XVI), studies suggest that there are often significant delays in diagnosis.74 For example, in a Danish series of 746 female patients (children and adults) with a karyotype compatible with a diagnosis of TS, the median age
Discussion
Short stature in infants, children, and adolescents may be due to variations in normal growth or to pathologic states. Accurate assessment and monitoring of growth in children is of critical importance for early identification of defects associated with treatable conditions versus growth variations associated with normal conditions.3 Key parameters related to growth should be monitored, including length or height according to age, weight, BMI, and HV compared with the mean of the reference
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Supported by Novo Nordisk.
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