1. -short stature (disease of height)
-failure to thrive (disease of weight)
Dipesh yadav
(Roll No:140,Group K, Batch: Aug-10)
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2. SHORT
STATURE
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3. Definition:
height below 3rd centile or more than 2
standard deviations below the median height
for that age and sex according to the
population standard.
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4. Etiology:
Physiological or normal variant short stature:
A. Familial
B. Constitutional
Pathological short stature
A. Under nutrition
B. Chronic systemic illness
• Renal: renal tubular acidosis, chronic renal failure, steroid
dependent nephrotic syndrome
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5. Etiology (cond.)
• Cardiopulmonary: congenital heart disease, cystic
fibrosis, asthma
• Gastrointestinal and hepatic: malabsorption, chronic
liver disease
• Chronic severe infections
C. Endocrine causes
• Growth hormone deficiency/ insensitivity
• Hypothyroidism
• Cushing syndrome
• Pseudohypoparathyroidism
• Precocious or delayed puberty
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6. D. Psychosocial dwarfism
E. Children born small for gestational age
F. Skeletal dysplasia, e.g.; achondroplasia, rickets
G. Genetic syndromes, e.g.; Turner
syndrome, Down syndrome
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7. Feature Familial Short Stature Constitutional Short
Stature
1) Sex Both equally affected More common in boys
2) Family History Of short stature Of delayed puberty
3) Height Velocity Normal Normal
4) Puberty Normal Delayed
5) Bone Age Normal Less than
chronological age
6) Final Height Short, but normal for
target
height
Normal
Comparison
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8. Detailed history
Careful examination
Laboratory evaluation
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9. Assessment of a child who presents
with short stature
• Accurate height measurement
• Assessment of body proportion
• Assessment of height velocity
• Comparison with population norms
• Comparison with child’s own genetic potential
• Sex maturity rating (SMR): Tanners staging
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10. Clues to etiology of short stature from
history
History Etiology
Low birth weight Small gestational age
Polyuria Chronic renal failure, renal tubular
acidosis
Diarrhea, offensive greasy stools Malabsorption
Neonatal hypoglycemia, jaundice,
micropenis
Growth hormone deficiency
Headache, vomiting, visual problem Pituitary/ hypothalamic space
occupying lesion
Lethargy, constipation, weight gain hypothyroidism
Dietary intake Under nutrition
Social history Psychosocial dwarfism
History for timing of puberty in
parents
Constitutional delay of growth10

11. Clues to etiology of stature from
examination
Examination finding Etiology
Disproportion Skeletal dysplasia, rickets,
hypothyroidism
Dimorphism Congenital syndromes
Pallor Chronic anemia, chronic renal
failure
Hypertension Chronic renal failure
Frontal bossing, depressed nasal
bridge, crowed teeth, small penis
Growth hormone deficiency
Goiter, coarse skin Hypothyroidism
Central obesity, striae Cushing syndrome
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12. Investigation:
Level 1 ( essential investigations):
1.Complete hemogram with ESR
2.BONE AGE
3.Urinalysis ( Microscopy, pH, Osmolality)
4.Stool ( parasites, steatorrhea, occult blood)
5.Blood ( RFT, Calcium, Phosphate, alkaline phosphatase, venous gas,
fasting sugar, albumin, transaminases)
Level 2 (investigations for short stature)
1.Serum thyroxin, TSH
2.Karyotype to rule out Turner syndrome in girls
Above is normal and bone age is delayed proceeds to level 2
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13. Investigation (contd.)
• If above investigations are normal and height between -2 to -3→
observe height velocity for 6-12 months
• If height < -3 SD → proceeds to level 3 investigations
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14.  Counselling of parents
( for physiological causes)
 Dietary advice
( Under nutrition, Celiac disease)
 Limb lengthening procedures
( skeletal dysplasia )
 Levothyroxine ( In Hypothyroidism)
 GH s/c injections ( GH deficiency, Turner syndrome)
 Monitoring with regular & accurate recording of height is
mandatory for a good outcome in any form of therapy
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15. FAILURE
TO
THRIVE 15

16. Failure to thrive
Definition:
• Is a term used for when a child’s weight for age is below the fifth
percentile or crosses two major percentile lines
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17. Etiology:
Organic causes:
• Gastrointestinal- gastro esophageal reflux,
malabsorption, inflammatory bowel disease,
pyloric stenosis
• Neurological- mental retardation, cerebral palsy
• Renal- renal tubular acidosis, chronic renal
failure
• Cardiopulmonary- congenital heart disease,
cystic fibrosis, asthma 17

18. • Endocrine- Hypothyroidism, diabetes mellitus,
adrenal insufficiency
• Infections- chronic parasitic or bacterial
infections of gastrointestinal tract, tuberculosis,
infection with HIV
• Genetic- Inborn errors of metabolism,
chromosomal anomalies
• Miscellaneous- lead poisoning, malignancy,
collagen vascular disease
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19. Non organic causes:
• Poverty
• Misperceptions or lack of knowledge about diet and feeding
practices
• Lack of breastfeeding, feeding diluted formulae
• Dysfunctional parent-child relationship with abuse & neglect
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20. • Clinical features:
 Poor growth
 Poor development
 Poor cognitive function
-the degree of FTT is measured by weight,
height and weight for height as percentage of
median value for age on appropriate growth
charts
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21. • Diagnosis:
 History
 Physical examination
 Observation of parent-child interaction
 Weight gain in response to adequate calorie feeding
establishes the diagnosis of psychological FTT
• Management:
 Nutritional rehabilitation
 T/t of organic causes if present
 Remedial measures for psychological factors involved
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22. Indications for hospitalization
• Severe malnutrition
• Diagnostic & laboratory evaluation needed
for organic cause
• Lack of catch up growth during outpatient T/t
• Suspected child abuse or neglect
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