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When to worry about short children

Posted on April 20, 2016

An infant’s size at birth mostly relates to the environment they are exposed to in their mother’s womb whereas growth after the first few months of birth is influenced more strongly by genetic factors.

Children grow most rapidly during the first year of life and then slow down during early childhood to about 5-7 cm per year in mid-childhood. Then they have a growth spurt of around 10-12 cm/year during puberty. This occurs about 11.5 years in girls and 13.5 years in boys on average.

 ‘Normal” growth in children is defined by reference to growth charts with centile lines that define the normal range. For example, 3% of normal children will have a height less than the 3rd centile. Height needs to be measured accurately with a device called a stapediometer and measurements need to be repeated over time.

It’s normal for children to cross one or two percentile lines in the first two years of life but after that they should generally follow the same centile line fairly closely. If a child is growing below the 3rd centile but still following parallel to the centile line, then they are probably okay. Only about 1 in 5 children below the 3rd centile will have a medical reason for being short.

If a child is below the 3rd centile and or crossing centiles downwards for height or is short for their family, they should be seen by a doctor and a referral to a Paediatric endocrinologist may be indicated.

The commonest causes of short stature are having short parents, familial short stature, or being predisposed to having a later than average pubertal growth spurt, called constitutional delay. If your child has other medical or developmental concerns, then they are more likely to have a medical cause for being short. If they are also underweight or if they have gastrointestinal symptoms, abnormal energy or sleep patterns, had a low birth weight or have other abnormalities they should have further investigations. 

Useful investigations include an X-ray of the left wrist for bone age assessment and blood tests to exclude thyroid disease and other endocrine problems including measures of growth hormone function.

Growth hormone is used to treat short children with a variety of medical problems such as Turner’s or Prader-willi syndromes or those with proven growth hormone deficiency. It can also be used to treat short children without an identified cause, called idiopathic short stature.  Staff at Sydney Paediatric Endocrinology are qualified to investigate short children and determine if they are likely to benefit from growth hormone treatment.