select(all_of(nor_check)) %>% pivot_longer(cols = everything(), names_to = “variable”, values_to = “value”)## Concerns
Referral is done to specialist like pediatric endocrinologist, nutritionist and gastroenterologist
Short stature
- short stature of less than 3rd percentile or < -2 SD
- SD < -3 (severe short stature) need urgent referral as most cases are likely to be pathological
- height velocity below cutoffs
- <5.5 cm for 2-4 yrs
- <5 cm for 4-6 yrs
- <4 cm for 6 yrs to puberty
- height disproportionate for mid-parental height (± 8.5 cm from the MPH) i.e., less than 1.6 SD for target height
- failure of SGA to catch-up growth by 2 years
Tall stature
- tall stature more than 97th percentile or > + 2 SD
- height crossing more than 2 SD upwards - accelerated growth
- signs of precocious puberty
Faltering growth
- weight for age less than -2 SD
- weight for height/length less than -3 SD
- failure to respond to initial outpatient nutritional treatment
- weight curve crosses two or more than 2 major percentiles downward
Red flag signs
- disproportionate growth - either short limbs/short trunk
- dysmorphic facies - genetic syndromes like down’s and turner
- neurological symptoms - severe headache, vomiting, visual changes suggestive of mass affecting pituitary gland
- signs of chronic disease - persistent diarrhea, bloody stools, signs of hypothyroidism
- delayed puberty (after 13 for girls and after 14 for boys) and precocious puberty (before 8 for girls and 9 for boys)