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Growth retardation
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Growth retardation

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Contributors: Christine Osborne MD, Marilyn Augustine MD
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Synopsis

Short stature refers to a child whose height is ≥2 standard deviations below the mean for sex and age and may be a normal growth variant or secondary to underlying disease. Normal variants of growth failure include:
  • Familial short stature – Low-normal growth velocity throughout life with normal bone age.
  • Constitutional growth delay – Results in childhood short stature, as children grow at a low-normal rate but have normal adult height. Puberty is typically delayed, with bone age correlating to height age.
  • Idiopathic short stature – Height below 2 standard deviations of the mean for age and sex without identifiable underlying cause.
In addition, there are several pathologic causes of growth failure including:
  • Undernutrition – Low height-for-weight with inadequate caloric intake.
  • Glucocorticoid therapy – Causes decreased growth via interference of endogenous growth hormone secretion and bone formation. Catch-up growth may occur with cessation of steroids.
  • Gastrointestinal (GI) disease – Decreased height velocity before the onset of GI symptoms (Crohn disease, ulcerative colitis, Celiac disease) and are often underweight for height.
  • Renal disease – Growth failure is seen in 1/3 children with renal disease due to dietary restrictions, anorexia, uremia, metabolic acidosis, or use of steroids for treatment.
  • Rheumatologic disease – Conditions, especially juvenile idiopathic arthritis, are associated with growth failure thought to be secondary to inflammatory cytokines and corticosteroid therapy.
  • Genetic causes – Turner syndrome, Noonan syndrome, Prader-Willi syndrome, Russell-Silver syndrome, and various skeletal dysplasias lead to short stature.
  • Endocrine diseases – Characterized by excess weight-for-height and may be secondary to Cushing syndrome, hypothyroidism, or growth hormone deficiency.
  • Cancer – Poor growth can be seen during treatment for cancer due to negative side effects of chemotherapy, although catch-up growth may be seen once therapy is completed. Late effects of cranial radiation therapy may be seen due to hypothalamic damage.

Codes

ICD10CM:
P05.9 – Newborn affected by slow intrauterine growth, unspecified

SNOMEDCT:
444896005 – Growth Retardation

Differential Diagnosis & Pitfalls

See the synopsis for a list of the differential diagnosis for growth retardation.

Best Tests

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Updated: 08/05/2016
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Growth retardation
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Growth retardation : Short stature
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