How to assess tall stature

Tall stature, above 98th centile for height, and greater than 2SD above mean, in most cases is familial. The mid-parental centile should always be evaluated. Other common causes are obesity or early normal puberty, but precocious puberty should be excluded in every child. Precocious puberty, hyperthyroidism and GH excess will cause rapid height velocity at any age and needs appropriate management. Where height centile exceeds mid-parental centile prediction, look for genetic syndromes, metabolic conditions and sex chromosome abnormalities. Constitutional tall stature i.e. physiologically normal advanced growth and development is a diagnosis of exclusion and treatment is rarely required. Treatment options include early and accelerated induction of pubertal development with a physiological sex hormone regimen, or epiphysiodesis, but need to be considered before puberty onset. High dose sex steroids are no longer indicated.