These are two problems or i would say concerns for which Parents commonly consult their pediatrician.
Before going into the details let us first try to understand what is normal growth and development.
GROWTH as you all know is influenced by many factors which include hereditary or genetic factors, environmental factors such as nutrition and the overall health of the child.
Growth is the most rapid in the first year of life and then slows down between 1-2 yrs of age .After 2 years the linear growth keeps on declining averaging approximately 5cms per year until it reaches a nadir just before the initiation of Pubertal growth spurt.During the Pubertal growth spurt the growth rate can go up to 6-11cms in girls and 7-13cms in boys.
Between 4 years and adolescence ,a growth rate brlowc4cms per year for both boys and girls should raise concerns and be evaluated.
SHORT STATURE It is defined as a height that is more than two standard deviations(SD) below the mean for age and sex7
GROWTH FAILURE It is abnormal linear growth velocity for age and sex which if persistent can lead to short STATURE.
Accuracy in measurement of recumbent length and standing height is key to correct diagnosis.
Recumbent length is measured up to 2yrs after which standing height is measured for which one requires an INFANTOMETER and aSTADIOMETER respectively with correct technique.Intervals of 4-6months between measurements are reasonable.
- Children with short STATURE can also have a normal growth velocity and this includes children with familial short STATURE and constitutional delay in growth.On the other hand subnormal growth velocity (growth failure) should elicit concerns of some underlying disease either Genetic syndromes like TURNER,NOONAN,RUSSEL-SILVER,and DOWN SYNDROME
- To make things simple Children with Short STATURE can be divided into 2 groups based on their skeletal maturation
1. Short stature with concordant bone age e.g familial short STATURE
2. Short STATURE with delayed bone age e.gConstitutional delay of growth.
On the other hand ,CHILDREN with Growth Failure are more likely to have pathological reason like Endocrine Disorder(Growth Hormone deficiency, GH insensitivity,Hypothyroidism,CushingSyndrome)
Non endocrine cause (malnutrition, Chronic illness and Psychosocial)
Accompanied by Delayed skeletal maturation .
It is important to measure body segment upper and lower segment.Disproportionate body segment should elicit suspicion for Chondrodysplasi and Rickets.
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