Growth delay, Stunting, constitutional growth delay, disproportionate short stature, familial short stature, skeletal dysplasia, chronic disease, endocrine disease, percentile; z score, growth rate
The algorithm presents a systematic approach to children suspected of stunting. In the first instance, it must be verified that the measurement is carried out correctly, and the percentile or z-score is subsequently calculated and recorded. This is followed by the correct integration of a detailed clinical history and physical examination that encompass the pre- and perinatal period, as well as family characterization. A child with short stature or a child with normal stature but with the presence of warning signs should undergo further investigation. The investigation must begin by calculating and representing growth speed (cm/year), considering a minimum interval of six months between measurements. In the presence of a normal growth rate and in the absence of warning signs, it is more likely to be the presence of a non-pathological cause of short stature, which includes familial short stature such as constitutional delay in growth and puberty. In these cases, the objective is to reassure the family and maintain annual monitoring of bone age calculation and biannual monitoring of growth speed. In the presence of short stature or growth failure, associated with reduced growth speed, there is a high probability of associated pathology. An additional study beyond the summary assessment is therefore justified, which encompasses a general analytical study and an analytical study appropriate to clinical suspicion. Here too, a targeted physical examination and a detailed clinical history are essential. When faced with a disproportionate short stature, one must think about skeletal dysplasias. Proportional short stature can be academically divided into prenatal and postnatal causes. Prenatal causes include genetic diseases, such as synd. by Turner and Sind. of Prader Willi and intrauterine growth restriction. Postnatal causes are divided according to the weight/height ratio. Chronic diseases such as celiac disease, inflammatory bowel disease, chronic kidney disease and malnutrition lead to a decreased weight/height ratio. Endocrine diseases such as hypothyroidism, growth hormone deficiency and Cushing’s syndrome occur with an increased weight/height ratio, with normal or increased weight. These children must, at some point during the evaluation, be referred for pediatric consultation for continuation of the study and future guidance.
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