Follow-up of Children and Adolescents with Short Stature: the Importance of the Growth Rate

Context And Objective: Short stature is defined as a height of more than two standard deviations below the average for a given age and sex in a reference population. The objective was to describe follow-up conducted among short-stature children and adolescents.

Design And Setting: Descriptive study, at the Growth outpatient clinic, Department of Pediatrics, Universidade Federal de São Paulo.

Methods: The study included 152 patients aged 2 to 15 years who had height for age of less than P5, on the National Center for Health Statistics curve. The children underwent nutritional evaluation, and several variables relating to height and growth rate were calculated to establish etiological diagnosis. Bone age was evaluated by X-ray.

Results: The majority (63.2%) were male. In 77.8%, the stature observed was within the family pattern. Among the 99 patients followed up for more than 6 months, 17.2% presented inadequate growth rates. The preponderant etiological diagnosis for short stature was familial/constitutional in 58.6% of the cases; 27 patients (34.2%) with adequate growth rate presented bone age alterations. Even with inadequate growth rates, 75% of such patients had a normal result from growth hormone stimulation testing. Close to 90% of patients with a diagnosis of short stature of familial/constitutional origin and intrauterine growth retardation presented adequate growth rate. The genetic etiology was significantly characteristic of patients with inadequate growth rate.

Conclusion: Growth rate assessment must form part of the investigation and follow-up of short-stature cases. However, its utilization and validity should form part of an overall view of each patient.