Short stature refers to a child whose height is ≥2 standard deviations below the mean for sex and age and may be a normal growth variant or secondary to underlying disease. Normal variants of growth failure include:
Familial short stature – Low-normal growth velocity throughout life with normal bone age.
Constitutional growth delay – Results in childhood short stature, as children grow at a low-normal rate but have normal adult height. Puberty is typically delayed, with bone age correlating to height age.
Idiopathic short stature – Height below 2 standard deviations of the mean for age and sex without identifiable underlying cause.
In addition, there are several pathologic causes of growth failure including:
Undernutrition – Low height-for-weight with inadequate caloric intake.
Glucocorticoid therapy – Causes decreased growth via interference of endogenous growth hormone secretion and bone formation. Catch-up growth may occur with cessation of steroids.
Renal disease – Growth failure is seen in 1/3 children with renal disease due to dietary restrictions, anorexia, uremia, metabolic acidosis, or use of steroids for treatment.
Rheumatologic disease – Conditions, especially juvenile idiopathic arthritis, are associated with growth failure thought to be secondary to inflammatory cytokines and corticosteroid therapy.
Cancer – Poor growth can be seen during treatment for cancer due to negative side effects of chemotherapy, although catch-up growth may be seen once therapy is completed. Late effects of cranial radiation therapy may be seen due to hypothalamic damage.
Codes
ICD10CM: P05.9 – Newborn affected by slow intrauterine growth, unspecified
SNOMEDCT: 444896005 – Growth Retardation
Differential Diagnosis & Pitfalls
To perform a comparison, select diagnoses from the classic differential