Introduction

• The growth of child needs to be interpreted in the context of their genetic potential, thus knowing the child’s mid-parental height (see below). Chronic illness will have an impact on growth, and therefore screening for underlying medical conditions is important.
• If weight centile is lower than height centile, slow linear growth is less likely to relate to an endocrine problem and a general paediatric opinion or dietetic review may be more appropriate
• If age less than 18 months, a general paediatric opinion should be sought in the first instance

When to refer

• Height for age less than 3rd centile.
• Height out of keeping with mid-parental height
• Concern regarding dropping height centiles
• Associated features suggest an underlying cause with associated endocrinopathy (eg clinical features of Turner syndrome).

Issues to consider

• For those presenting with short stature in late puberty, a bone age (BA) can help to assess whether intervention to improve height may be possible. Girls with BA of ≥14years and boys with BA ≥16years have reached final height (hence should be informed that no intervention is going to impact on height). Suggest exclude associated pathology as a reason for poor growth (eg hypothyroidism, coeliac disease, renal dysfunction). Referral to endocrinology may still be appropriate; however such cases will not be triaged urgently.

Initial work up

• Calculate mid-parental height:
  • for girls: (maternal height in cm + paternal height minus 13cm) divided by 2
  • for boys: (maternal height in cm + paternal height plus 13cm) divided by 2
  • for both girls and boys, the normal range for final height is 8.5 cm on either side of the calculated value.
    
• Full blood count; electrolytes; bone chemistry (Ca/Phosphate); IGF1; TSH/freeT4; coeliac serology, liver function tests, ESR
• Chromosomal karyotype in females to exclude Turner syndrome.
• Bone age X-ray
• Please note: random growth hormone levels are not helpful, given the pulsatile nature of growth hormone release

Referral information needed

• Current height and weight (including date)
• Any previous available measurements (with dates)
• Pubertal status: Tanner stage
• Mid parental height
• Previous medical history
• Initial investigations as above

Contact information

• For clinical advice, the endocrinology fellow or endocrinologist on call can be contacted through the hospital switch board (03) 9345 5522
• Outpatient booking enquiry information (03) 9345 6180

Author

• Guideline developed by RCH Endocrinology Department
• Guideline first published - December 2022
• Guideline next review date December 2024