Children with familial short stature, unlike those with constitutional growth delay, have a bone age that is consistent with their chronological age. For children with constitutional growth delay or accelerated growth, it is more accurate to use bone age, rather than chronological age, to determine projected height. Projected adult height is obtained by extrapolating along the current height percentile curve for up to 18–20 years of age. The family doctor plays a pivotal role in early detection, timely treatment, appropriate referrals and close monitoring of ‘catch-up’ growth in these children.įamilial short stature – these children have a projected adult height that is within their anticipated adult height, based on mid-parental height.( 6) Mid-parental height is calculated in the following ways: (a) for girls, subtract 13 cm from the father’s height and find the average with the mother’s height (b) for boys, add 13 cm to the mother’s height and find the average with the father’s height and (c) for both genders, 8.5 cm on either side of this calculated value represents the 3rd–97th percentiles for anticipated adult height. Iron deficiency is the most common complication. Child neglect or abuse should always be ruled out. Other causes are malabsorption and existing congenital or chronic medical conditions. ‘Picky eating’ is common in the local setting and best managed with an authoritative feeding style from caregivers. In Singapore, the most common cause of failure to thrive in children is malnutrition secondary to psychosocial and caregiver factors. Premature babies with appropriate growth velocity and children with ‘catch-down’ growth, constitutional growth delay or familial short stature show normal growth variants, and usually do not require further evaluation. Diagnosis requires repeated growth measurements over time using local, age-appropriate growth centile charts. Failure to thrive in a child is defined as ‘lack of expected normal physical growth’ or ‘failure to gain weight’.
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