Kids who are short for their age but otherwise healthy probably don't need
extensive blood tests to determine if a disease is stunting their growth,
researchers said in a new study.
Of 235 short kids without symptoms who were referred for specialty testing,
just three had a possible diagnosis picked up on those labs, and only one
diagnosis - for celiac disease - was confirmed, researchers found.
"Most of the screening tests are for diseases you really wouldn't want to
miss, but it's rare that any of those diseases (would only) present with short
stature," said by Dr Stephanie Sisley, who led the study.
Guidelines on short stature from endocrinology groups recommend lab screening
for very short children, including those who don't have any problems picked up
on a physical exam.
That screening includes blood tests for thyroid and growth hormones as well
as calcium and other nutrients. But one of the authors of those guidelines
agreed that based on the new findings, kids who are short but have no other
symptoms probably don't need extensive screening.
Sisley and her colleagues reviewed the medical charts of 1 373 short children
who were referred to the endocrinology clinic at Cincinnati Children's Hospital
Medical Center between 2008 and 2011. Of them, 235 were below the third
percentile for height and had a normal check-up and no record of having stopped
A 10-year-old girl who is four feet, one inch tall would fall just below the
third percentile, for example, as would a six-year-old boy who is three feet,
five inches. Few of those children underwent all tests recommended by the
guidelines; the average kid had about two-thirds of them. One was diagnosed with
celiac disease - when the body can't process certain grains - and two others had
signs of underlying conditions but didn't finish follow-up tests.
There were 10 false-positive lab results that didn't pan out on further
testing. Altogether, the tests cost $315 321 - or $105 107 per possible
diagnosis, the study team reported in The Journal of Pediatrics.
Sisley and her colleagues said their findings show many children are
inappropriately referred to specialists for short stature.
Take note of symptoms
Rather than looking at a child's height at one point, it's more important to
track it over time to see if a kid has stopped growing, they wrote.
"Any patient who really isn't growing should be checked out," Sisley, now at
Baylor College of Medicine in Houston, told Reuters Health.
Dr Alan Rogol, a professor emeritus at the University of Virginia in
Charlottesville, agreed the new findings only apply to those kids who are short
but have no record of growth delay.
The kids in this study "had nothing that pointed to difficulty in any system,
and many of them were short kids of shorter parents," said Rogol, who reviewed
the study for the journal.
He and Sisley both said those kids should be followed by their paediatrician
for at least six months - then referred to a specialist if they really aren't
growing, or any time new symptoms show up.
"In this idealised set of kids, the things that paediatricians do best are
probably more worthwhile than sending them over to see an endocrinologist or
somebody else," Rogol said.
"I think parents are most worried that they're missing something in the kid.
It's actually okay to follow the growth of a patient for six months or 12 months
to see if something's going on before you do specialised testing," Sisley
"Much of the time, if their child is otherwise healthy, the bottom line is
they're probably going to be fine in the long run."