Short stature and growth problems
Many short children are healthy. This page explains when short stature needs checking, what the growth chart and bone age show, and who growth hormone helps.
What does short stature mean?
A child is called short when their height is below most children of the same age and sex, usually under the 3rd percentile of the growth chart. This is a description, not a diagnosis of illness. Three in every hundred healthy children also fall below this line.
Why does the path matter more than the number?
A single measurement says little. Once several dated measurements sit on the chart, the doctor can see whether a child has kept to their own path or fallen away from it. After the age of three or four and before puberty, most children grow about 5 to 6 cm a year. A child who grows less than this year after year needs checking, even if they do not yet look short.
The most common causes
- Family height: the parents are short and the child grows at a normal speed on a lower path.
- Late development: the child reaches the growth spurt and puberty later than others and often catches up later. Someone else in the family has usually done the same.
- General illness: anaemia, coeliac disease, kidney or bowel problems, and any long-term illness that reduces nutrition and growth.
- Hormonal causes: an underactive thyroid, growth hormone deficiency and too much cortisol. These are less common than the causes above.
- Other causes: being small at birth without catching up, and some genetic conditions such as Turner syndrome in girls.
What needs checking?
- Growth that has slowed, or a child falling below their own percentile
- Height that does not fit with the parents’ heights
- Height that stalls while weight goes up
- A body that looks out of proportion, or a different appearance
- Short stature with long-lasting diarrhoea, great tiredness, headaches or changes in vision
- A girl who is very short, even with no other sign
How does the assessment go?
It starts with talking and an examination: birth and feeding, the parents’ heights, and all earlier heights and weights. Sometimes that is enough, and measuring again after a few months is all that is needed. If necessary, blood tests and a bone age X-ray are asked for. A growth hormone stimulation test is only for children in whom the doctor suspects a shortage of this hormone.
Treatment
Treatment depends on the cause. Family height and late development usually need no treatment, only follow-up. An underactive thyroid or coeliac disease improves with its own treatment. Growth hormone is used only for some causes, and the decision follows proper checks. Nobody can promise a final height.
What can you do?
Measure your child properly every few months and write it down with the date. Find older heights and weights in the health booklet, the health center or the school. Ask a doctor before using any height supplement or medicine.
Frequently asked questions
My child has always been the shortest in the class. Is that an illness too?
Not necessarily. A child who has been short from the early years, keeps to their own path and has a short parent is often healthy. Even so, looking at the growth chart once is worthwhile.
Do sport or extra sleep make a child taller?
Enough sleep, food and activity are needed for healthy growth, but they do not add height beyond what a child's genes and health allow.
Until what age is there time?
Height increases while the growth plates in the bones are open. If you are worried, do not wait until the teenage years are over, because some treatments work only before these plates close.
The first step is a calm measurement.
Talk to the support team to arrange a visit. If you have your child's earlier heights and weights, find them and bring them along.