India · WHO reference ranges · Growth faltering · GH deficiency detection · Puberty-aware · IAP aligned
First line: Bone age (X-ray wrist), TFT, FBC, ESR, coeliac screen (anti-tTG IgA)
Second line: IGF-1, IGFBP-3, GH stimulation test (paediatric endocrinology)
Also consider: Renal function, karyotype (girls), nutritional assessment
| Age range | Boys (cm/yr) | Girls (cm/yr) | Alarm (< this value) | Action |
|---|---|---|---|---|
| 0–1 year | ~25 | ~24 | <18 | Assess nutrition, systemic illness |
| 1–2 years | ~12 | ~11.5 | <8 | Monitor; investigate if persistent |
| 2–3 years | ~8–9 | ~8 | <6 | Screen for coeliac, TFT |
| 3–4 years | ~7–8 | ~7 | <5.5 | Full growth screen |
| 4–10 years | 5.5–7 | 5.5–7 | <4 | Bone age, IGF-1, GH stimulation |
| Pubertal peak ♂ (~13yr) | 9–12 | — | <6 | Delay puberty assessment |
| Pubertal peak ♀ (~11yr) | — | 8–10 | <5 | Assess pubertal staging, TFT |
Height velocity (cm/year) = (Height at visit 2 − Height at visit 1) ÷ (Age at visit 2 − Age at visit 1 in years). Annualise by dividing the height gain by the fractional year elapsed. Example: a child measures 106 cm at age 5 years 0 months and 109 cm at age 5 years 6 months. Interval = 0.5 years. Velocity = (109 − 106) ÷ 0.5 = 6 cm/year. Compare to expected median of ~6.4 cm/year for age 5 — this is within the normal range.
A child on the 3rd centile with a normal height velocity of 6 cm/year is growing normally for their genetic potential (constitutional short stature or familial short stature) — no investigation needed. The same child with a height velocity of 3 cm/year is falling off their centile — this is pathological and warrants urgent investigation. Height velocity is therefore the most sensitive marker for growth disorders, superior to height centile alone. Track height velocity at every follow-up visit, not just height.
Classic GH deficiency presents with height velocity below 4 cm/year in mid-childhood, declining centile position, delayed bone age, and often normal or slightly overweight body habitus. In India, GH deficiency is under-diagnosed — children are often labelled "nutritionally short" without proper evaluation. If height velocity is below the alarm threshold and nutritional and systemic causes have been excluded, refer to a paediatric endocrinologist. IGF-1 and IGFBP-3 are good screening tests; GH stimulation testing remains the gold standard for diagnosis.