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The evaluation of growth and the identification of growth hormone deficiency
  1. Amanda J Drake,
  2. Christopher J H Kelnar
  1. Department of Child Life and Health, University of Edinburgh, Edinburgh, UK
  1. For correspondence:
    Professor Christopher Kelnar
    Department of Child Life and Health, University of Edinburgh, 20, Sylvan Place, Edinburgh EH9 1UW, UK; chris{at}

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The assessment of child growth is a routine part of child health care worldwide.1 Growth monitoring is important in the early detection of disease in children and of particular value in detecting a wide variety of endocrine abnormalities in which poor growth may be the earliest, or only, sign of a problem.2 However, although measurement of height is regarded as an important component of paediatric care worldwide, national practices vary widely.3,4 Additionally, despite its widespread use, little is known about the diagnostic performance of growth monitoring in terms of its sensitivity and specificity for the detection of growth disorders and of its impact on child health.4–6 In the United Kingdom, this has resulted in the most recent recommendations from a UK National Health Service review which suggest that height monitoring in childhood should be reduced to a single measurement at the age of 5 years.7 In this article we discuss some of the issues related to growth monitoring, the investigation of short stature and the management of a number of specific conditions associated with growth failure.


There is a wide variation in height within and between populations and the interpretation of growth must therefore be based on appropriate reference data. Short stature can be arbitrarily defined as a height below the 2nd or 3rd centile for age (approximately 2 standard deviations (SDS) below the mean).


Short stature is not a disease and normal is not the same as average. Most children referred with short stature have no evidence of underlying pathology and will have genetic short stature and/or constitutional delay. Many studies dealing with the psychosocial consequences of short stature are based on children referred for investigation, who are therefore more likely to be those with other pathology or greater problems with …

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