For early detection of pathological causes of growth failure proper referral criteria are needed, as well as a thorough clinical, radiological and laboratory assessment. In this minireview we first discuss the two consensus-based and one evidence-based guidelines for referral that have been published. The evidence-based guidelines result in a sensitivity of approximately 80% at a false-positive rate of 2%. Then, relevant clues from the medical history and physical examination are reviewed, and specific investigations based on clinical suspicion listed. In the absence of abnormal clinical findings, an X-ray of the hand/wrist and a laboratory screen are usually performed. Scientific evidence for the various components of laboratory screening is scarce, but accumulated experience and theoretical considerations have led to a list of investigations that may be considered until more evidence is available.

Growth, Growth disorders, Short stature, X ray analysis, bone dysplasia, clinical feature, diagnostic approach route, diagnostic procedure, differential diagnosis, endocrine disease, evidence based practice, false positive result, growth disorder, growth hormone deficiency, hand, history of medicine, human, iatrogenic disease, malnutrition, metabolic disorder, pathology, physical examination, priority journal, psychosocial disorder, radiology, screening, sensitivity analysis, short stature, short survey, small for date infant, wrist,
Hormone Research
Erasmus MC: University Medical Center Rotterdam

Oostdijk, W, Grote, F.K, de Muinck Keizer-Schrama, S.M.P.F, & Wit, J.M. (2009). Diagnostic approach in children with short stature. Hormone Research, 72(4), 206–217. doi:10.1159/000236082