GPAtlas🧭 When to suspect
Short stature is conventionally defined as a height below the 2nd centile (−2 standard deviation score [SDS]) for age and sex on a UK–WHO growth chart.
The great majority of short children are entirely well. The two commonest patterns are:
• Familial short stature: the child is short but tracking appropriately for their parents
• Constitutional delay of growth and puberty: a slow-but-normal tempo with late puberty
Separate these normal variants from the minority in whom short stature signals:
• A chronic illness
• An endocrine or genetic disorder
• Psychosocial deprivation
What drives growth changes with age, and this directs the history:
• In the first 2–3 years growth is mainly nutrition-dependent
• From around 3 years to puberty it is driven by growth hormone and thyroid hormone
• Through puberty the sex hormones and growth hormone produce the pubertal growth spurt
Two principles matter more than any single reading:
• Growth is a trend, not a point – a child can be growing abnormally while still on a ‘normal’ centile
• A child may be short simply because their parents are short
Both are judged by plotting serial heights and by comparing the child’s centile with the mid-parental centile.
| Trigger for assessment | Definition |
|---|---|
| Symptomatic short stature | Short stature plus symptoms or signs of chronic illness |
| Significant short stature | Height below the 2nd centile (≤ -2 SDS) |
| Severe short stature | Height below the 0.4th centile (≤ -2.7 SDS) – refer regardless of other features |
| Short for the family | Height more than 3 centile spaces below the mid-parental centile |
| Growth failure | A sustained fall of more than 1 centile space (reduced height velocity) in a child aged 2 or over |
In the last two scenarios the child’s height need not be below the 2nd centile – crossing centiles downward, or being far shorter than the family pattern predicts, warrants assessment in its own right.
Source: RCPCH UK–WHO growth charts · BSPED Growth Disorders SIG
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