环球焦点！我的孩子太矮了吗？

这是达医晓护的第3956篇文章

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在门诊经常会有家长忧心忡忡的来问，我家孩子好像比别的孩子矮，会不会是你们医生说的矮身材啊，医生有什么办法给我们检查一下吧，有什么办法改善吗？

什么是矮身材？

身材矮小指个体的身高低于同年龄同性别的人，而矮身材这个术语在儿科我们通常会用于定义身高在生长曲线上低于第三个百分位数的儿童。

什么样的身高增长是需要我们引起注意的？

在现实生活中，我们每个人都有不同的身材和身高，而且会有些人个子不高。如果孩子仅仅因为明显比他的同学矮，并不意味着这个孩子不健康。

一些家长常常会认为他们的孩子个子矮，根本没有长高。其实大多数时候，情况并非如此。在就诊时我们首先会问父母的就是，孩子是否一直会有衣服和鞋子太小穿不下。比如，从春天到秋天，孩子的裤子都变短了吗？你需要在每学年开始时买新鞋吗？

如果答案是肯定的，那么孩子很可能正在正常成长。如果一个孩子年复一年穿着相同的衣服，而新衣服只是用来替换旧衣服，那么情况就不同了。

另外，生长速度的变化也是需要引起重视的。如果孩子的身高50%百分位数上，那通常我们不会认为孩子矮，但如果孩子的生长曲线图上显示之前一直处在90%的百分位附近，最近一年下降到了50%，那就意味着存在问题，需要我们干预的。所以，在确定孩子的生长是不是存在异常时，每年常规的儿保检查和生长曲线图表至关重要

一般来说，3岁以前每年生长小于7厘米，3岁到青春期以前每年生长小于5厘米，青春期每年生长小于6厘米时，就认为生长速度减慢，应及时来找儿科医生就诊。

矮身材是什么原因引起的？

身材矮小本身不涉及个体的健康问题，大多数矮身材的人除了身高矮小外，都过着正常健康的生活。抑或有些孩子是“晚长”——在某个阶段比预期的要矮，但随着他们的年龄增长，身高会逐渐赶上大部队。然而，在一些儿童中，身材矮小可能意味着存在潜在的问题。

孩子矮小的原因有很多。一个常见的原因是家族性身材矮小，就是指父母身材矮小，遗传导致。

体质性生长和青春期延迟是另一个常见原因，如同上面提到的，我们称为“晚长”。通常情况下，这类孩子在童年的大部分时间都很矮，由于骨龄延迟，而且青春期开始较晚，生长通常比正常情况持续时间更长，成年后会达到相对正常的身高范围。这些孩子，在高中后期突然有了突飞猛进的身高增长是很正常的。体质性生长和青春期延迟和家族性身材矮小通常都被认为是正常的变异。

有时，一些潜在的疾病会导致生长发育不良，而身材矮小可能是这些疾病影响身体整体健康的第一个表象。几乎所有影响主要器官的慢性疾病都可以让孩子出现生长问题，包括罹患心脏病、哮喘、乳糜泻、肠易激综合征、糖尿病、肾脏疾病、贫血和骨骼疾病，以及肿瘤，正在化疗的儿童。有营养不良，小于胎龄出生史或胎儿或宫内生长受限史也会导致生长延迟型身材矮小。

除了全身性疾病影响外，生长激素缺乏症是导致矮身材的内分泌原因之一，同样还有甲状腺功能减退、性早熟等。库欣病时，因为身体分泌过多皮质醇、或长期高剂量类固醇治疗也会导致生长迟缓。

遗传疾病，包括Down综合征、Turner综合征、Silver-Russell 综合征和 Noonan综合征会影响生长，有时这些疾病的初始表现就为为身材矮小，由儿科医生在排查身材矮小的病因中发现。

有什么方法诊断呢？

如果孩子可能存在身高生长的问题，为了评估孩子的状况，通常医生会从以下方面开始评估：

1. 精确测量孩子的身高，并收集之前的数据，绘注于标准生长发育曲线图上；

2.根据孩子的年龄、健康状况、家庭和发育史评估他们的身高；

3.检查孩子的身体比例（体重、坐高）以及是否存在遗传疾病的外部特征；

4.根据孩子手腕的X光图像评估其骨龄。

5.医生可能还需要进行一些特定的测试，包括相关的血液检查和生长激素激发试验，以帮助正确诊断孩子身材矮小的原因。

What is short stature?

A person with short stature simply means he or she has not grown as tall as other people their age and sex. The term is applied to children whose height, when plotted on a growth curve in the pediatrician"s office, is below the line marking the third percentile.

What kind of growth pattern is atypical?

The reality is we come in a wide-variety of shapes and sizes and there are going to be short kids. Just because a child is significantly shorter than his classmates, doesn’t mean the child isn’t healthy.

Some parents tend to think their child is short and not growing at all. Most times, that’s not the case. One of the first things I ask parents is if their child is consistently outgrowing clothes and shoes. Is the child’s pants getting shorter from spring to fall? Do you need to buy new shoes at the beginning of each school year?

If the answer is yes, then most likely the child is growing normally. If a child is wearing the same clothes year-after-year and new clothes are only needed to replace old worn out clothes, then that’s a different scenario.

The variation of the growth velocity is also a concern. If a child measures at the 50 percentile that child is not necessarily short. However, if that child had been growing at the 90 percentile and dropped to the 50 percentile that could indicate a problem. Growth charts are critical and important for children to have routine wellness checks to have their growth measured accurately year-after-year.

Generally, it indicates a slow growth rate if a child grows less than 7cm per year before 3yrs old, 5cm per year from before puberty, or 6cm per year during puberty.

What causes short stature?

Short stature in itself is not a medical problem; most people in this category are simply naturally short and lead normal, healthy lives. Many children are "late bloomers" - at one stage shorter than expected, but then "catch up" as they mature. However, in some children, short stature can indicate an underlying medical problem.

There are a multitude of reasons why a child may be short. A common reason is familial short stature, which means the parents are short.

Constitutional delay in growth and puberty is another cause, which means the child is a late bloomer. Typically, a child is short during most of childhood but will have late onset of puberty and end up in the typical height range as an adult because the child will have more time to grow. It’s not unusual for someone who has been small all their life to suddenly have a growth spurt late in high school. Both constitutional delay and familial short stature are considered variants of normal.

Sometimes, there are underlying medical conditions that lead to poor growth development, and short stature may be the first sign something else is going on. Chronic medical conditions affecting nearly any major organ, including heart disease, asthma, celiac disease, inflammatory bowel disease, kidney disease, anemia, and bone disorders, as well as patients of a pediatric oncologist and those with growth issues as a result of chemotherapy. Poor nutrition, a history of being born small for gestational age or with a history of fetal or intrauterine growth restriction could also cause short stature.

Growth hormone deficiency is another cause, as well as hypothyroidism, growth hormone deficiency, diabetes, but they are not as common. Cushing disease, in which the body makes too much cortisol, or prolonged high dose steroid treatment, also cause growth delay.

Genetic conditions, including Down syndrome, Turner syndrome, Silver-Russell syndrome, and Noonan syndrome have effects on growth. Sometimes present with short stature as the initial clinical manifestation.

Methods for diagnosis

In order to assess your child"s status, doctor will :

Measure your child"s height and previous data against standard growth and development curves;

Evaluate your child"s height based on their age, health status, and family and developmental history;

Examine your child for physical proportions (weight, sitting height) and outward signs of genetic conditions, and;

Evaluate your child"s bone age from an X-ray image of their hand and wrist.

Doctor may also want to perform specific tests, including blood tests and growth hormone stimulation, to correctly diagnose the cause of your child"s short stature.

作者：澳大利亚墨尔本大学医学院儿科博士

百汇医疗（中国）儿科医师

蒋本然