Referral guideline – Short stature

Introduction

Short stature – defined as having a height below the 3rd percentile for age and sex – is a common problem affecting up to 5 children out of every 100.

Although this may be the normal pattern of growth for an individual child, underlying causes of poor growth should be considered. The process of growth is dependent on adequate nutrition, normal bone structure and biochemistry, normal thyroxine, growth hormone and other hormones as well as general health. Disruption of normal growth may therefore be an indication of many abnormal conditions. Parents who are short usually have children whose height is in the lower range of normal.

Constitutional delay of growth is the most common cause of short stature in childhood. This is a variant of normal and is usually associated with a delay in maturation and with late puberty. Constitutional short stature often runs in families.

Children with growth hormone deficiency are small compared to other children of their age and their growth rate is poor, so they fall behind their peers.

GP management

  • Calculate mid-parental height:
    • either plot the measured height centile of the parents and take the mid-point, or;
    • for girls: maternal height in cm + (paternal height minus 13cm) divided by 2
    • for boys: paternal height in cm + (maternal height plus 13cm) divided by 2
    • for both girls and boys, the normal range is 8.5 cm on either side of the calculated value.
  • Full blood count; electrolytes; bone chemistry (Ca/Phosphate/ALP); urine culture and dipstick; IGF1; TSH/freeT4; tissue transglutaminase (tTG).
  • LH/FSH only in infants or in children over 9 years (no use in ages in between).
  • Chromosomes only useful in females to exclude Turner syndrome.

When to refer

  • Immediately if downward trajectory of height-for-age percentiles on growth chart
  • If more than 2 centile lines below mid-parental height / outside family pattern
  • Short stature / poor growth with any symptoms, especially visual or headache

Essential referral info

  • Height, weight of child and parents
  • Previous growth records or percentile charts
  • Family history of endocrine disorders
  • Patient details
  • Medicare number
  • Parent/carer name and contact details
  • Referring clinician details (name, contact details, provider number, date and length of referral)

From 1 May 2019 referral criteria will apply at CHQ. This condition has minimum demographic and essential clinical referral information that is required to be included prior to submission of the referral. Visit the CPC website for the required condition. If you are unable to provide the required “essential information” please state the reason when you submit the referral.

Helpful referral info

  • Past history including perinatal events and birth size

Parent service

Endocrinology

Contact details

Hospital Switchboard
(Ask for the endocrinology fellow or registrar)
t: 07 3068 1111