Stature

Objective: No adequate methods exist for predicting stature to help assess the growth of handicapped (including mobility-impaired) children or to help in developing indexes of obesity or equations for estimating basal energy expenditure for adults. In this project, equations were developed to predict stature in white and black adults and children from nationally representative samples for application to mobility-impaired and handicapped persons.

Outcome measures: The NHES is the only national survey that contains body measurements biologically appropriate for predicting stature. These measurements include stature, sitting height, knee height, and buttocks to knee length.

Stature

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Results: Knee height predicted stature for white and black men, but the predictor variables for white and black women were knee height and age. For predicting stature in children 6 to 18 years of age, the predictor variable was knee height for all children.

In medico-legal autopsies, establishing personal identity of the victims is often required. Estimation of stature from extremities and their parts plays an important role in identifying the dead in forensic examinations. The study examines the relationship between stature and dimensions of hands and feet among Rajputs of Himachal Pradesh -- a North Indian endogamous group. The purpose for understanding these examinations was the paucity in the literature of studies that allow the reconstruction of stature from various dimensions of hands and feet amongst Rajputs. Hand length, hand breadth, foot length and foot breadth of 246 subjects comprising 123 males and 123 females ranging in age from 17 to 20 years were taken independently on left and right side of each individual. Statistical analyses indicated that the bilateral variation was insignificant for all the measurements except hand breadth in both the sexes (P

Infants (birth to 24 months) must be measured for length, and the sex appropriate length-for-age or weight-for-length charts for infants, birth to 36 months must be used to plot the measurements. At age 24 months and older, if children can stand unassisted and follow directions, stature should be measured and plotted on the stature-for-age chart for children (2 to 20 years). Otherwise, between 24 and 36 months, length can be used in place of stature.

BMI-for-age charts are recommended to assess weight in relation to stature for children ages 2 to 20 years. The weight-for-stature charts are available as an alternative to accommodate children ages 2-5 years who are not evaluated beyond the preschool years. However, all health care providers should consider using the BMI-for-age charts to be consistent with current recommendations.

All individual 2000 CDC growth charts have an initial publication date of May 30, 2000. For various reasons, modifications were made to charts after the initial publication date. For example, the individual charts were modified to create the clinical charts, which were made available on October 16, 2000. Subsequent modifications were made to selected clinical charts to correct or enhance particular aspects of the scales on the graphs. In all cases, the data points in the corresponding data file for each modified chart remain unchanged from the initial release on May 30, 2000. Where applicable, when selected clinical charts were further modified, the date is indicated on each chart. The clinical growth charts for stature-for-age were modified because the scale for inches was not correctly aligned with the metric scale. The clinical growth charts for infant length-for-age and infant weight-for-age were revised to improve the appearance of the scale for inches on the length charts by extending the indicators at inch increments, and enhancing alignment of the English with the metric scales on both the length and weight scales.

Short stature is defined as a height more than two standard deviations below the mean for age (less than the 3rd percentile). Tall stature is defined as a height more than two standard deviations above the mean for age (greater than the 97th percentile). The initial evaluation of short and tall stature should include a history and physical examination, accurate serial measurements, and determination of growth velocity, midparental height, and bone age. Common normal variants of short stature are familial short stature, constitutional delay of growth and puberty, and idiopathic short stature. Pathologic causes of short stature include chronic diseases; growth hormone deficiency; and genetic disorders, such as Turner syndrome. Tall stature has the same prevalence as short stature, but it is a much less common reason for referral to subspecialty care. Common causes of tall stature include familial tall stature, obesity, Klinefelter syndrome, Marfan syndrome, and precocious puberty. Although most children with short or tall stature have variants of normal growth, children who are more than three standard deviations from the mean for age are more likely to have underlying pathology. Evaluation for pathologic etiologies is guided by history and physical examination findings.

The first step in the evaluation of a child with suspected short or tall stature is to obtain accurate measurements and plot them on the appropriate growth chart. For infants and toddlers, weight, length, and head circumference should be plotted on a growth curve at every visit. For patients two to 20 years of age, weight, height, and body mass index should be plotted. Length should be measured using a horizontal rule in children younger than two years, and height should be measured using a wall-mounted stadiometer in children older than two years. Because children grow in spurts, two measurements at least three to six months apart, and preferably six to 12 months apart, are needed to accurately determine growth velocity.4

Variation from this normal pattern of growth may be a sign of pathologic conditions. Although most children with short or tall stature do not have a pathologic condition, extremes of height, especially beyond three standard deviations, require further workup.

Short stature is defined as a height more than two standard deviations below the mean for age, or less than the 3rd percentile. Idiopathic short stature is defined as a height less than two standard deviations below the mean for age without a known etiology.

If the initial evaluation suggests a genetic, endocrine, or gastrointestinal disorder, laboratory testing should be performed (Table 4).1,3,13,14,16,19,20 In an asymptomatic child with short stature, an evaluation of the growth curve may provide clues to the underlying pathology. Underweight in a child with short stature suggests a systemic illness or malnutrition, whereas overweight suggests an endocrine disorder.2,21

Different causes of short stature tend to fall within identifiable growth patterns, and a review of a child's growth curve and bone age should guide further evaluation. Children with familial short stature or idiopathic short stature have a bone age equivalent to their chronologic age, and children with constitutional delay of growth and puberty or endocrine disorders have a bone age that is less than their chronologic age. Because the bone age of a child with endocrine diseases will progressively fall behind chronologic age, calculating bone age every 12 months might be useful to differentiate constitutional delay of growth from endocrine diseases.1

If findings from the initial evaluation do not suggest a diagnosis, laboratory testing may be performed (Table 4).1,3,13,14,16,19,20 A retrospective study found that a complete laboratory evaluation of an asymptomatic child with idiopathic short stature is low yield and expensive. The two diseases that were most often identified in the studied cohort were celiac disease and an abnormality of the growth hormone axis.3 If history and physical examination findings do not suggest a cause, a complete blood count, comprehensive metabolic panel, and measurement of bone age, insulinlike growth factor 1, and insulinlike growth factor binding protein 3 might be useful to screen for chronic disease and growth hormone deficiency. Karyotyping in girls might also be reasonable because short stature and delayed puberty may be the only symptoms in some girls with Turner syndrome.

Children with short stature and no identified cause and children with certain other identifiable causes of short stature should be referred to a pediatric endocrinologist. Table 5 lists the indications for referral.2,6,22

Recombinant growth hormone is approved for a variety of conditions that cause short stature, including Turner syndrome, chronic renal failure, Prader-Willi syndrome, small for gestational age, Noonan syndrome, short stature homeobox-containing gene deficiency, and idiopathic short stature. It is administered through daily injections over several years. The injections are generally well tolerated, but rare adverse reactions have been reported. For children with idiopathic short stature, four years of treatment results in an increased height of 3.7 cm (1.46 in) and costs between $100,000 and $120,000.25,26

Oxandrolone (Oxandrin) is an oral anabolic steroid that has been shown to increase height velocity but has little effect on final height. Insulinlike growth factor has been used in children with insulinlike growth factor deficiency. Although aromatase inhibitors have been used in children with idiopathic short stature, long-term effectiveness and safety data are not available.27

Tall stature is defined as a height more than two standard deviations above the mean for age (greater than the 97th percentile). Evaluation may also be needed in a child who has a normal height, but a projected height more than two standard deviations from the midparental height. Figure 2 is an algorithm for the evaluation of tall stature.19 Although the percentage of children with tall stature is equal to that of children with short stature, children with tall stature are much less likely to be referred to subspecialty care. be457b7860