Introduction

This guideline relates to short stature in paediatric patients.  

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 (e.g. clinical features of Turner syndrome)

Note: 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.

Referral criteria/required information

• 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

How to refer

RCH Specialist Clinics Referral.pdf

Please complete the above and submit via:

• Fax (03) 9345 5034 or
• Email screferrals@rch.org.au
• Urgent referral or clinical query call ED admitting officer, endocrinology fellow or endocrinologist on-call (03) 9345 5522 

Suggested pre-referral work-up/management 

• 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

• Blood sampling:
• • Full blood count (FBC)
  • Electrolytes
  • Bone chemistry (Ca/Phosphate) 
  • IGF1
  • TSH/freeT4
  • Coeliac serology
  • Liver function tests (LFT)
  • ESR
• Chromosomal karyotype in females to exclude Turner syndrome
• Bone age X-ray

Note: random growth hormone levels are not helpful, given the pulsatile nature of growth hormone release

Acknowledgements

The development of this guideline was coordinated by the Department of Endocrinology. Guideline reviewed in July 2025.