|
TALL STATURE
Children with
tall stature, i.e. above the 99.6th centile, are usually so
because of genetic reasons - they simply have tall parents! This is
referred to as constitutional tall stature. However, tall stature may
also be associated with various paediatric syndromes that require
specialist assessment. Two of these conditions are Marfan syndrome and
Sotos syndrome.
Constitutional tall stature
Tall stature
in childhood usually presents less initial concern than short stature
because, at least in early childhood, being tall can be advantageous.
However, excessive tall stature can cause problems, particularly at
school. It may be difficult to remember that a five-year old child who
has the stature of an eight-year-old only has the educational and
emotional development of a five-year old. Their size can seem
inappropriate for their classroom peers and so very tall children may
be labelled as clumsy or aggressive.
Other treatments that reduce growth hormone secretion are being evaluated
through clinical trials. As a final option, a surgical reduction of
leg length is a possibility.
If extreme tall stature is associated with psychological or behavioural
difficulties then treatment can be offered. The older treatment option
of sex steroids (oestrogen in girls and testosterone in boys) is not
as effective as previously believed in slowing growth and there may be
side effects. Theoretically, sex steroids rapidly fuse the growing
ends of the bones and so stop growth prematurely. However, they also
induce a growth spurt so on balance the outcome may be disappointing.
Diagnosis: From around 2-4 years of age. Tall stature and dysmorphic
features
Sotos syndrome, or gigantism, usually presents in early childhood. The
physical characteristics are tall stature, large hands and feet and
poor circulation. There may also be special educational needs. Bone
age is often advanced and puberty usually occurs early so excessive
tall stature may not be a feature of adulthood.
Typical growth chart for Sotos Syndrome.
|
Jacob's Story
My Sister and Sotos