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Primary Care Liaison

Short stature

  • 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


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