This document discusses short stature, defined as height below the 3rd percentile or more than 2 standard deviations below the median height for age and gender. It notes that 3% of children will be short and discusses physiological and pathological short stature. Assessment of growth patterns includes accurate height measurement, assessment of height velocity, comparison to growth charts and genetic potential, and bone age assessment. Causes of short stature include hormonal deficiencies, skeletal dysplasias, and malnutrition. Management depends on the underlying cause and may include counseling, a balanced diet, hormone replacement therapy, growth hormone injections, or limb lengthening procedures.

1. AJAY SAH
Disoders Of Growth

2. Short Stature
 It is defined as height below 3rd centile or more than
2S.D. below the median height for age & gender (<-
2S.D.)
 3% of children in any given population will be short
 <-3S.D. :- Pathological short stature
 In b/w -2 & -3 S.D. :- Physiological short stature

3. Etiology

5. Assesment in Growth Pattern
Accurate Height Measurement:
 Infantometer (For children below 2yrs)
 Stadiometer ( For children above 2yrs)
Assessment of height velocity:
 1st yr : 25cm/yr
 Pre-Pubertal : 4-6 cm/yr
 Puberty : 10-12 cm/yr
Growth Chart comparison with normal
Population.

6. Comparison with child own genetic
potential:

7.  Assessmentof Body Propotion : (US:LS ratio)
 1.7 at Birth
 1.3 at 3 yrs
 1.1 by 6 yrs
 1 by 10 yrs
 0.9 in Adults
 Increase US:LS ratio in Rickets, Achondroplasia & Untreated Congenital
Hypothyroidism
 Decrease in Spondyloepiphyseal dysplasia & Vertebral Anomalies

8. Bone Age Assessment
 Should be done in all children with short stature
 Conventionally from radiograph of left hand & wrist using Tanner
WhiteHouse Method or Greulich & Pyle (GP) Atlas
 Bone age is delayed compared to chronological age in almost all cases
of short stature Except:-
 Famlial short stature (Equals)
 Precocious Puberty (Exceeds)
 In case of GH defeciency & Hypothyroidism, Bone age may be lower
than height Age, if endocrine condition is diagnosed late.

11. Diagnosis

12. Investigation

13. Management
 The specific management depends on the underlying cause.
 Councelling of parents & dietary advice.
 Intake of balanced diet containing recommended amounts of macro &
micronutrients.
 For Physiological Causes: Reassurance & Annual monitoring of
height & weight is sufficient.
 Dietary Rehabilitation for Undernutrition.
 Hypothyroidism : Levothyroxine replacement
 GH deficiency : Daily S.C. injection of GH is recommended
 For Skeletal Dysplasia: Limb lenthening procedures
 For any form of therapy, Monitoring with regular & accurate recording
of height is mandatory for satisfactory outcome.

14. THANK YOU