Short stature, or shorter height, is a common reason for a visit to a pediatric endocrinologist, a specialist in growth and hormones. Short stature is roughly a height below the 3rd percentile on a standardized growth chart. Growth charts show the expected distribution of heights in the population, so some individuals are expected to be taller and some are expected to be shorter. Short stature does not always mean that there is an underlying health concern.
What Factors Affect Height
Pediatric endocrinologists consider many factors in assessing short stature:
Birth history. Being born early or born small for gestational age can affect length/height in the early years.
The rate, or how fast, a child is growing. Infants and toddlers grow the fastest; the rate of growth slows down in the early school age years and then increases again during puberty in the teenaged years.
Where a child is in puberty. The most growth happens in the middle of puberty, and before the first period for girls. Height growth stops after puberty is complete.
How tall parents are. The mid-parental height estimate, an adjusted average of the mother and father’s heights, gives a very rough estimate of how tall a child may be. There is a wide range on either side of this estimate.
Possible Testing
After consideration of all of these factors, a pediatric endocrinologist may recommend simply following growth over time or doing additional testing. Some tests that may be recommended are:
A bone age x-ray. This is a x-ray of the left hand and wrist that shows the growth plates. It can give an estimate of how old the bones “think” they are and how much longer a child may have to continue growing.
Blood tests for hormone problems. These may include looking at thyroid function or markers of growth hormone function.
Blood tests for other conditions. These may include looking for celiac disease, kidney problems, or liver problems.
Causes of Short Stature
Once all the necessary information is available, a pediatric endocrinologist can determine the likely cause for short stature. Common causes of short stature include:
Familial short stature (where most other family members also have short stature)
Delay of puberty (“late bloomers”)
Growth hormone deficiency
Turner syndrome (a chromosomal difference found in those assigned female at birth)
Undernutrition
Idiopathic short stature (short stature without a known cause)
And many others
Treatment of Short Stature
Treatment of short stature depends on the cause and may include growth hormone injections, testosterone injections, or increased caloric intake. Sometimes, no treatment is needed.
If your child is upset by their height, or is experiencing bullying at school, it is important to talk to their pediatrician or primary care provider. A referral to a pediatric endocrinologist may sometimes be necessary to make sure there is not an underlying problem. Other times, all that is needed is reassurance that a child is growing as expected and that they are healthy.
Jennifer Ladd, MD, MSc is on the endocrinology physician team at Nationwide Children's Hospital. She is also the founder and medical leader of the new Turner Syndrome Clinic at Nationwide Children's.
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