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Short Stature

What is short stature?

Short stature is a term used to describe a child who has not grown as tall as most other boys or girls their age. While short stature is somewhat subjective, it’s typically defined as a person growing below the third percentile. That means that in a group of 100 people, a child with short stature would be among the shortest three kids of the same age and gender.

Causes of short stature

There are many reasons why a child may be short, and they are not always cause for concern. One of the most common reasons is familial short stature, which means the parents are not tall.

Constitutional delay in growth and puberty is another cause, which means the child is a late bloomer. Kids with constitutional delay are often small during childhood. After puberty, they “catch up” and end up with a normal height. Both constitutional delay and familial short stature are considered variants of normal.

Sometimes, there may be underlying medical conditions that lead to poor growth development and short stature may be the first sign something else is going on. It takes a lot of energy for a kid to grow, so if the body is under any other type of stress, such as a thyroid issue, inflammatory bowel disease, or celiac disease, the child may not grow properly.

Growth hormone deficiency is another, less common cause. Growth hormone deficiency is typically suspected when a child is having less than normal growth over time. Growth hormone deficiency isn’t automatically the cause for very short kids. In fact, kids with normal height but poor growth can have growth hormone deficiency.

Signs and symptoms of short stature

Sometimes, parents are concerned that their child is short and not growing at all. Regular well checks with your child’s primary care provider can help establish their growth patterns and track changes over time. Another simple way to watch for growth concerns is to see whether your child is consistently outgrowing clothes and shoes. If a child is wearing the same size for several years and wearing out shoes and clothes before they outgrow them, that can be a sign of poor growth.

Diagnosing short stature

There are four indicators that can help determine if a child’s growth is typical:

#1. Current Height Percentile

The child’s current height percentile offers insight into their growth, but it’s important to remember that it is only one piece of the puzzle. A low height percentile doesn’t automatically mean there’s a problem.

#2 Growth Velocity

Growth velocity—the rate of a child’s growth over time—can be helpful in understanding what’s typical for your particular child. Growth charts are critical when determining short stature. That’s why it’s important for children to have routine wellness checks to have their growth measured accurately year after year.

For instance, a child who is measuring at the 50th percentile is not necessarily short, but a sudden drop from the 90th to the 50th percentile could indicate a problem.

Likewise, a child in the third percentile is short, but if they’ve always been growing at the third percentile, that's generally considered normal growth.

#3 Genetic Potential

A family’s genetic potential also impacts stature. If the parents are both short, it may be normal for the child to be short. It’s more concerning if the parents are tall, but the child is short for their age. With that said, children with short parents can still have abnormal growth.

Calculating your child’s mid-parental height can help provide insight into their growth patterns.

To calculate a boy’s mid-parental height: add the mother’s height plus five inches to the father’s height and divide by two.

To calculate a girl’s mid-parental height: add the father’s height minus five inches to the mother’s height and divide by two.

Ninety percent of kids will fall within two inches of their mid-parental height.

#4 How Much Time the Child Has Left to Grow

 Puberty plays a big role in growth. With puberty comes a large growth spurt, but once puberty is over, growth is complete. A bone age measurement helps doctors assess how much time a child has left to grow. Bone age is determined by taking an x-ray of the child’s wrist and comparing the maturation of the bones in the hand and wrist to standards. A child with delayed bone age has additional time to grow.

Treatment for Short Stature

An endocrinologist can help you determine if there is an underlying medical cause for your child’s short stature and explain the treatment options that are available. Sometimes, no treatment is needed. Depending on the specific cause, one of the following treatments may be helpful:

Growth hormone

Children who are growth hormone deficient or meet one of the other FDA-approved indications may receive treatment with growth hormone. It is administered as once daily injections, six to seven days a week, and typically is used until the growth plates fuse. However, if your child has a problem with their pituitary gland or other hormone deficiencies, treatment may be lifelong.

Aromatase inhibitors

Aromatase inhibitors are medications that are sometimes prescribed off-label (which means they are not an FDA-approved treatment for short stature) for boys with short stature. Your doctor may suggest this treatment if your child's bone age indicates they may need more time to reach their height potential before their growth plates fuse. These medications (letrozole or anastrozole) are taken as once daily oral tablets and block the conversion of testosterone to estrogen, the hormone that causes the growth plates to close in both boys and girls.

Testosterone or estrogen

If a child is showing significant delays in puberty and has short stature due to being a late bloomer, a short course of either testosterone (boys) or estrogen (girls) can help kick-start puberty and its associated growth spurt. Estrogen for girls is often given as a transdermal patch, while testosterone is given to boys as a monthly injection. A child who is simply a late bloomer will typically develop and grow in response to this treatment alone.

Choosing the best home for your child’s care

Children’s Mercy has one of the largest full-service endocrinology programs in the country. Children and teens with all types of endocrine concerns, including short stature or growth failure, can benefit from our comprehensive care approach.

Your family can connect with a Children’s Mercy endocrinology specialist at one of our Kansas City-area locations as well as at many of our outreach clinics across Kansas and Missouri. Ask your child’s primary care provider for a referral to the endocrinology program at Children’s Mercy.