Short stature Short stature is usually defined as a height below the second (i.e. two standard deviations below the mean) Measuring height velocity is a sensitive indicator of growth failure. Two accurate measurements at least 6 months but preferably a year apart allow calculation of height velocity in cm/year

Causes Familial: Most short children have short parents and fall within the centile target range allowing for mid-parental height.

Intrauterine growth restriction (IUGR) and extreme prematurity : About one-third of children born with severe intrauterine growth restriction or who were extremely premature remain short

Constitutional delay of growth and puberty : These children have delayed puberty, which is often familial, usually having occurred in the parent of the same sex. It is commoner in males. It is a variation of the normal timing of puberty rather than an abnormal condition. It may also be induced by dieting or excessive physical training. An affected child will not show the same sexual changes as his peers, and bone age would show moderate delay. The legs will be long in comparison to the back. Eventually the target height will be reached. The condition may cause psychological upset.

Endocrine : Hypothyroidism, growth hormone (GH) deficiency and steroid excess are uncommon causes of short stature. They are associated with children being relatively overweight, i.e. their weight on a higher centile than their height

Nutritional/chronic illness : This is a relatively common cause of abnormal growth. These children are usually short and underweight; i.e. their weight is on the same or a lower centile than their height. Inadequate nutrition may be due to insufficient food, restricted diets or poor appetite associated with a chronic illness

Chronic illnesses which may present with short stature include: coeliac disease, which usually presents in the first 2 years of life Crohn's disease chronic renal failure - may be present in the absence of a history of renal disease cystic fibrosis.

Psychosocial deprivation : Children subjected to physical and emotional deprivation may be short and underweight and show delayed puberty. This condition may be extremely difficult or impossible to identify, but affected children show catch-up growth if placed in a nurturing environment

Chromosomal disorder/syndromes : Many chromosomal disorders and syndromes are associated with short stature. Down's syndrome is usually diagnosed at birth, but Turner's, Noonan's and Russell-Silver syndromes may present with short stature. Turner's syndrome may be particularly difficult to diagnose clinically and should be considered in all short femal Whereas Turner's syndrome is associated with 45XO karyotype, Noonan's and Russell-Silver syndromes have no recognised chromosomal abnormality and diagnosis requires recognition of their clinical features