Evaluating Growth
Medical history (child and family)
A detailed medical history, including information about the pregnancy and birth, growth during infancy, illnesses, appetite, diet, medications and home environment, may provide the doctor with clues about the reasons for your child's short stature or slow growth.
As discussed previously, a child's height is influenced by the heights of the parents. Overall, children from small families tend to be shorter than average as adults. Because heredity (genetic potential) plays a significant role in determining height, the medical history will include information about family members. The heights of the child's parents and the growth patterns of siblings are valuable pieces of information.
It may be helpful to get information from the child's grandparents about anything unusual in the parents' growth patterns, especially the ages at which the parents went through puberty.
Your child's doctor will perform additional evaluations, since other factors – such as treatable medical conditions – also influence growth.
Physical examination
During a detailed growth evaluation, measurements of your child's weight and height will be obtained. These are plotted on the appropriate growth charts for comparison with normal ranges. It is also helpful if you are able to provide the doctor with any other measurements taken during your child's life – for example, your child's "baby book" or the measurements from the back of the bedroom door!
Additional measurements of your child's head circumference, arm and leg lengths or other body parts, may also be obtained. A careful examination will be performed to check for any signs of congenital conditions (conditions present at birth), chronic illness or hormone deficiencies.
Growth charts
As discussed earlier, the growth chart is an important tool used to determine if a child has a growth problem. By plotting a child's measurements on a growth chart over time, a doctor can determine if a child is growing normally or not. If a child's height falls downward across the percentile lines, he or she fails to grow over a period of time, is much shorter than other children of the same age or is much shorter than would be expected based on the parents' heights, tests may be required to determine the cause.
Bone-age evaluation
Your doctor may obtain an x-ray of your child's left hand and wrist – called a bone age x-ray – to evaluate the maturity of his or her bones.
The x-ray is compared with a series of standard x-rays of children at different ages to determine your child's bone maturity. Using this x-ray, a child's growth potential can also be determined – that is, how much remaining growth he or she has left. As with all growth measurements, there is a wide range of normal development. Having a bone age that is somewhat younger or older than a child's chronological age (or "calendar age" – the actual age since birth) is not unusual. However, if the bone age is extremely advanced or delayed, this may suggest an underlying growth problem. The bone-age evaluation is generally used along with the physical examination and growth charts to obtain a comprehensive picture of a child's growth and maturity.
Laboratory tests
Blood samples may be taken to look for evidence of any medical problems that can cause short stature or slow growth. These tests help your child's doctor determine if chronic illness, poor nutrition, bowel disorders or hormone deficiencies are affecting growth. To help confirm a diagnosis of growth hormone deficiency, more extensive testing – such as a growth hormone stimulation test – may be required. Such testing generally involves administration of one or two medications and collection of blood samples at several different times over a number of hours.
MRI scan
A special type of "brain scan" called a magnetic resonance imaging scan, or MRI scan, may be needed in some cases to look for any changes or disturbances in the area of the hypothalamus and pituitary gland.
Stimulation Testing
Information about stimulation testing can be found here.
