Keywords
Short stature, Failure to thrive
The most common reasons for deviant measurements are technical (i.e., faulty equipment and human errors). Repeating a deviant measurement is the first step. Separate growth charts are available and should be used for very low birthweight infants (weight <1,500 g) and for those with Turner syndrome, Down syndrome, achondroplasia, and various other dysmorphology syndromes.
Decision-Making Algorithm
Short Stature
Variability in body proportions occurs from fetal to adult life. Newborns’ heads are significantly larger in proportion to the rest of their body. This difference gradually disappears. Certain growth disturbances result in characteristic changes in the proportional sizes of the trunk, extremities, and head. Patterns requiring further assessment are summarized in Table 6.1 .
| PATTERN | REPRESENTATIVE DIAGNOSES TO CONSIDER | FURTHER EVALUATION |
|---|---|---|
| Weight, length, head circumference all <5th percentile |
|
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| Discrepant percentiles (e.g., weight 5th, length 5th, head circumference 50th, or other discrepancies) |
|
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| Declining percentiles |
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|
Evaluating a child over time, coupled with a careful history and physical examination, helps determine whether the growth pattern is normal or abnormal. Parental heights may be useful when deciding whether to proceed with a further evaluation. Children, in general, follow their parents’ growth pattern, although there are many exceptions.
For a girl, midparental height is calculated as follows:
Paternal height ( inches ) + Maternal height ( inches ) 2 − 2.5
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