Examining a short stature child :o

First of all, how u classify causes of short stature?

Answer: It can be classified into:
(A) Physiological causes
 Familial (Means whole family memang all short)
 Constitutional delay in puberty (Meaning the short stature is not permanent, its
due to familial delay in puberty, causing the patient to looked shorter than kids of
the same age but in the end, normal height will be achieved. It is normally following
parents of the same sex. Meaning a girl will normally have her mother with history of
delay puberty while a boy will have his father with history of delay puberty)

(B) Pathological causes

(I) Antenatal
 IUGR
 Prematurity
 Syndromic (Down, Turner, Prader Willi syndrome ) (For our level, knowing the
first 2 is adequate)

(II) Post natal

 Endocrine causes (Hypothyroidism, low growth hormone,
hypercortisolism, panhypopituitarism)
 Chronic illness (Heart failure renal failure, chronic lung disease, celiac
diseases, Chron disease)
 Malnutrition
 Psychological (Neglect, deprivation)

Now, after knowing these, come to our main concern~~~~~~~

In the exam, if u get a child with short stature, normally examiner will give u
some scenario like: “This child is brought by her mother here to see u. Mother
complain to u that her child looks shorter than his/her friend of the same
age. Please examine the child.” So what you should do is as follow:
1) Measure height, weight and head circumference and plot on a correct
growth chart (Mind that there are 2 different growth charts, one for normal
and one for Down syndrome). By measuring these, u can get some info:
 If the patient is short and fat with excessive body weight:
Causes of short stature most probably due to endocrinopathy
(Hypothyroidism, excessive cortisol, low growth hormone, Prader Willis
Syndrome)
 If the patient is short and extremely thing with low body weight:
Causes of short stature most probably due to chronic illnesses and
malnutrition

2) Measure the upper and lower segment and comparing the ratio
Upper segment (US) is our trunk of body, value obtained by~~ Height – lower
segment (LS)
Lower segment (LS) is the lower half of our body~~ Ask patient to stand and
measure from pubic symphysis to the floor
Interpretation:
 Normal ratio of US:LS = 1.0
 If ratio > 1.0 meaning the lower limbs are short, suggestive of some
disorders such as Rickets, achondroplasia…
 If ratio <1.0 meaning the trunk/upper segment is short, suggestive of
maybe scoliosis/mucopolisaccharidosis

3) Measure mid parental height

Male = (height of parents + 13)/2
Female = (height of parents – 13)/2
Any deviation of the kid’s height from the value by 5cm suggestive of
pathological short stature.

4) Measure arm span

5) Proceed with general examination (Mainly look for features of those
pathological causes of short stature)
Hand
 Features of Down syndrome: Simian crease, Sydney crease, clinodactyl
 Features of Turner syndrome: Spoon shape nail, depressed 4th and 5th
knuckles
Pulse
Look for bradycardia suggestive of hypothyroid
Wrist
Look for wide wrist suggestive of Rickets
Reflexes
Hyporeflexia suggestive of hypothyroidism
Carrying angle
Widened in Turner syndrome
Head
Look for scars---possible post opt scars of pituitary tumour
Face
 Features of Down syndrome: Low set ears, epichantal fold,
hyperthelorism, depressed nasal bridge, protrusion of tongue)
 Features of Turner syndrome: Low set ear, epichantal fold, micrognathia
(Small chin)
 Features of Rickets: Frontal bossing
 Features of hypothyroidism: Coarse facies, macroglossal, dry skin
 Features of Cushing: Moon face
Neck
Web neck suggestive of Turner syndrome
Chest
 Wide spread nipple suggestive of Down/Turner syndrome
 Richitic rosary suggestive of Rickets

Abdomen
 Look for striae suggestive of hypercortisolism
 Undecended testes…(Might suggest of midline defect, which will be
associated with congenital missing of pituitary gland, causing
hypothyroid, low growth hormone…)
Legs
 Features of hypothyroidism: Dry skin, myxoedema
 Features of rickets: Bowing of legs

Finally you will say that: I would like to complete my examination by doing
Examination for:
 Neurological system
 Visual field examination (Look for bitemporal hemianopia suggestive of
pituitary mass)
 CVS examination (To look for cardio anomaly in syndromic child)
 Look for lateralizing signs

Add on: Some good examiner will give u scenario like: “Ok, this child come to u
and mother complaining to you regarding the short stature of the child and
also the notice that the child is having visual problem, please examine the
child” ~~~ So when u hear this, u should suspect that this child might be having
pituitary disorders as visual problem is a big clue suggestive to u that this child
might be having bitemporal hemianopia which is due to pituitary mass.
Don’t be stress buddies, hahahaaa… relax and have some fun here…spot
diagnosis of each picture below: (p/s: this is just me too free so put some
picture for guessing here, not from Dr Suhaimi H ya, hahahaaaaa)

(Picture A)

(Picture B)
 (Picture C)

(Picture D)

(Picture E)
 (Picture F)

(Picture G)
Answer:
A –Down Syndrome
B- Prader Willi syndrome
C- Web neck (Turner syndrome)
D- Coarse facies with facial puffiness (Hyothyroidism)
E – Bilateral bowing of tibia (Rickets)
F- Rachitic rosary (Rickets)
G- Spoon shape nail (Turner syndrome)

_____________________________ FINISH_____________________________
GOOD LUCK EVERYONE!!! =)