Disorders of growth

Most children who have short or tall stature are healthy and simply at the extremes of the normal range. Plotting a child on a centile chart is a way of comparing their height with the rest of the population. Following the child over time helps to assess whether the pattern of growth is normal. Children settle onto a centile position by 2 or 3 years of age, and after this a normal child grows fast enough to stay on the same centile until puberty. During puberty, sex steroids stimulate growth directly and increase growth hormone (GH) secretion, leading to the pubertal growth spurt. Most short children are growing in a normal pattern and do not have anything wrong with them. Any short child whose pattern of growth is abnormal (reduced growth velocity) should be investigated. Endocrine causes of reduced growth velocity include GH deficiency and hypothyroidism. In Turner's syndrome and skeletal dysplasia, GH secretion is normal but the skeletal response is abnormal. GH treatment is effective in increasing height in children with GH deficiency and some other short stature disorders. Most children presenting with short stature do not benefit from GH treatment.