Mid-parental height is used to estimate a child's genetically determined height potential. It is calculated differently for boys and girls based on the average of the parents' heights. This value is plotted on a growth chart at age 18-20 to estimate the child's target height percentile. Evaluating short stature involves ruling out common causes through blood tests and imaging. If these are normal, tests are done to check for growth hormone deficiency, hypothyroidism, and Turner syndrome. Growth hormone therapy can increase final adult height by 20-30 cm for children with growth hormone deficiency.

1. Akshai George Paul

2. MID PARENTAL HEIGHT
 Parents height significantly affects the child's height
 Mid parental height gives an approximate estimate of
child's genetically determined potential.

3.  MPH for boys=mothers+fathers height in cm +6.5
 2
 MPH for girls=mothers+fathers height in cm -6.5
 2

4.  This value is then plotted on the growth chart at 18-20
yrs of age.
 This is an estimate of target height for the child and
the percentile that he or she is likely to follow.

5. GROWTH CHART BOYS

6. GROWTH CHART GIRLS

7. INVESTIGATIONS
Laboratory evaluation of short stature involves
step wise application of diagnostic tests to determine
the etiology

8. STEP 1
☺The first step in investigation is to rule out
common causes.
☺This involves exclusion of
malnutrition,chronic systemic illness
and recurrent infection

9. ☺It is by using complete blood counts,erythrocyte
sedimentation rate,chest x ray,serum electrolyte and
liver and renal function tests.
☺Tissue transglutaminase antibody (coeliac disease)
and venous blood (renal tubular acidosis) should be
performed if the screening tests are normal.

10. ☺Estimation of skeltal maturation forms an important
aspect of evaluaton of short stature.
☺This is done by comparing the X ray of left wrist with
age specific norm.

11. STEP 2
The next step in evaluation involves evaluation for
hypothyroidsm (free T4 and TSH) and Turners
syndrome (karyotype) in all girls.

12. STEP 3
☺ Evaluation for GH-IGF axis is performed only after
other common causes of growth retardation have been
excluded.
☺This is important as systemic illness and
hypothyroidsm influence the GH-insulin like growth
factor axis.

13. ☺Random or fasting blood GH level measurements
donot confirm the diagnosis of GHD as hormone
secretion is pulsatile.
☺The diagnosis of GHD thus requires pharmacological
stimulation tests

14.  GHD is suspected when peak level of GH is <10 ng/ml
following stimulation.
 The common provocative agents used are
insulin,glucagon and clonidine.
 Levels of IGF-1 and IGF binding protein 3 are helpful
to diagnose GHD and Laron syndrome.

15. 😊 GHD may be associated with other pituitary hormone
deficiencies and appropriate investigations should be
carried out to detect deficiencies of these hormones if
GHD present.
😊 CT or MRI scan of hypothalamic and pituitary regions
are essential to rule out developmental or neurological
diseases

16. MANAGEMENT
GENERAL MEASURES
😊 Patient should be advised in diet rich in protein and
calorie content.
😊The should be encouraged to increse their physical
activity.iron and vitamin deficiencies should be
corrected.
😊Zinc supplimentation(10 mg/day for 3 to 6 months)
may help in improving growth in patient with
idiopathic short stature.

17. SPECIFIC THERAPY
Initiation of specific treatment is effective in
restoring growth in hypothyroidism(thyroxine),celiac
disease(gluten free diet)and renal tubular
acidosis(bicarbonate suppliment).

18.  A short course of testosterone may be given to boys
with constitutional delay of puberty and growth.
 Treatment of genetic syndrome and skeletal dysplasia
is extremely difficult. Some of them do not respond to
GH therapy.
 Bone lengthening(illizaro technique)has been used
with variable success in some forms of skeletal
dysplasia

19. GROWTH HORMONE
🙂GH is highly effective in patients with GHD. This can
result in a increase in hight by 20 to 30cms.
🙂The treatment given as daily night time injection (25 -
50 micro gram /kg/day) till epiphyseal closure.
🙂 The treatment is expensive and hence should be
started only if it can be given regularly for atleast 2
years.

20. The role of GH is expanding with increase in use in
turner’s syndrome,chronic renal failure,small for
gestational age infants who failed to catch up,russel
silverman syndrome,prader willi syndrome and
idiopathic short stature

21. GREULICH AND PYLE CHART
 These are one of the most widely accepted method of
skeltal age determination
Underlying the construction of the Greulich and
Pyle atlas are the assumptionsthat,in healthy
children,skeletal maturation is uniform,that all
bones have an identical skeletal age, and that the
appearance and subsequent development of body
centers follow a fixed pattern.

22. However,considerable
evidence suggests that a wide
range of normal variation
exists in the pattern of
ossification of the different
bones of the hand and the
wrist and that this variation is
genetically determined.