Çocuklarda Normal Büyüme ve Boy Kısalıklarına Yaklaşım
Synopsis
Growth is a fundamental physiological process continuing from the intrauterine period until the end of adolescence, reflecting a child's health, nutrition, and genetic background. While insulin is effective in prenatal growth, nutrition gains importance in the first two years of life, followed by thyroid and growth hormones, and sex hormones during puberty. The height velocity is expected to be 25 cm in the first year, 10–12 cm in the second year, and 5–6 cm per year from age four until puberty. Measurements should be performed lying down under 2–3 years of age and standing over three years of age; body proportions such as sitting height and arm span should be measured to evaluate disproportionate short stature. Short stature is defined as a height below the 3rd percentile or below -2 SD according to chronological age and gender. Its causes are classified into normal variant and pathological short stature. In familial short stature within the normal variant group, bone age equals chronological age (CA=BA>HA), whereas in constitutional growth delay, bone age is compatible with height age (CA>BA=HA) and puberty is delayed. Pathological short statures are divided into proportionate and disproportionate. Clinical evaluation includes detailed history, physical examination, target height calculation, Tanner staging, laboratory tests, celiac screening, karyotype analysis in girls, and bone age determination on left hand-wrist radiographs using the Greulich Pyle atlas. In suspected growth hormone deficiency, IGF-1, IGFBP-3, and stimulation tests are evaluated. A pediatric endocrinologist should be consulted when height SDS is below -2 SD or when height velocity decreases.
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