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Delayed GrowthAka: Growth Assessment

See Also
1. Failure to Thrive
Algorithm
1. Determine if growth is truly delayed
  1. See Calculation of Growth Delay
2. Determine when growth delay began
  1. See Growth Delay Onset Determination
Physical Exam
1. Weight Measurement in Children
2. Height Measurement in Children
3. Body Mass Index
4. Weight for Height Age
5. Indicators of collagen bone disease
  1. Examples
    1. Osteochondrodysplasia
    2. Metaphyseal dysostosis
  2. Abnormal Arm Span
  3. Upper to Lower Segment Ratio
  4. Shortness
    1. Disproportionate shortness ("Dwarf")
      1. Arms and legs short compared with trunk
    2. Proportionate shortness
      1. "China Doll" Shortness
  5. Linear Growth Velocity
  6. Tanner Staging (See Tanner Staging)
Physical Findings: Term Newborn
1. Micropenis (size <2.8 cm stretched)
  1. Assess for Luteinizing hormone deficiency
  2. Associated with panhypopituitarism
2. Congenital Nystagmus
  1. Assess for septo-optic dysplasia
  2. Associated with Growth Hormone deficiency
Radiology
1. Bone Age Films
Labs: Routine
1. Urinalysis
2. Complete Blood Count
3. Erythrocyte Sedimentation Rate (ESR)
4. Chemistry panel (Chem7)
5. Liver Function Test
6. Serum Calcium
7. Serum Phosphorus
8. Alkaline Phosphatase
9. Serum Iron
Labs: Specifically indicated
1. Assessment for Gluten Sensitive Enteropathy
  1. Anti-Gliadin antibodies titers
  2. AntiEndomysial antibody titers
2. Assessment for Cystic Fibrosis (under age 2 years)
  1. Sweat Chloride
3. Assessment for Growth Hormone deficiency
  1. IGF-1
  2. IGF-binding protein #3
4. Assessment for Hypothyroidism
  1. Free T4
  2. Thyroid Stimulating Hormone (TSH)
Diagnostic Criteria
1. Familial Short Stature
2. Constitutional Short Stature

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This page was written by Scott Moses, MD, and was last revised 1/26/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 5.0.