Faltering growth (short stature, drop across centiles)

Paediatrics · Symptom or situation · updated 2026-10-30

BioMG follows French guidelines. Adapt it to the guidelines and the tests available where you practise.

Short stature or faltering height

Laboratory tests

FBC
Serum ferritin (if anaemia, microcytosis or nutritional or digestive clue)if neededAnaemia or microcytosis on the FBC, with a nutritional pointer (restrictive diet, possible iron deficiency) or digestive pointer (coeliac disease, inflammatory bowel disease): anaemia can reveal iron deficiency, coeliac disease or IBD ^[1]. The Dutch screening measures iron and ferritin only if haemoglobinopathy is suspected in an at-risk population ^[1]; serum ferritin is not part of the French baseline tests ^[2].
CRP (if inflammatory or digestive clue)if neededInflammatory or digestive pointer: abdominal pain, diarrhoea, blood or mucus in the stools, fatigue, arthritis; slowing of growth in height with poor weight gain (Crohn's disease, juvenile arthritis) ^[2]. Dutch screening suggests it (with the white cell count and faecal calprotectin) in children aged 10 or over whose height is flattening and whose BMI is low or falling, and it can be considered earlier with the same profile ^[1]. The French baseline tests include the erythrocyte sedimentation rate, which is no longer in the fee schedule ^[2,3]. The Italian consensus (2026) places CRP among the tests to request in primary care for any short stature ^[4]; neither serum ferritin nor serum albumin features there ^[4].
Serum electrolytes
Bicarbonate
Serum creatinine
Serum calcium
Serum phosphate
Alkaline phosphatase
ASTif needednon-French guidelineChronic disease or suspected liver disease: an American Family Physician review suggests liver and kidney tests when the clinical picture points to liver or kidney disease (expert opinion, 2015) ^[5], and the 2026 Italian consensus counts transaminases and GGT among the tests to do in primary care for any short stature ^[4]. The French paediatricians' baseline tests do not include them ^[2]. Liver disease also lowers IGF-1 ^[6].
ALTif needednon-French guidelineChronic disease or suspected liver disease: an American Family Physician review suggests liver and kidney tests when the clinical picture points to liver or kidney disease (expert opinion, 2015) ^[5], and the 2026 Italian consensus counts transaminases and GGT among the tests to do in primary care for any short stature ^[4]. The French paediatricians' baseline tests do not include them ^[2]. Liver disease also lowers IGF-1 ^[6].
IgA anti-tissue transglutaminase antibodies (tTG-IgA)
Total IgA measurement
TSH
Free T4
IGF-1
Blood karyotype (in girls; signed consent form enclosed)if neededIn a girl of short stature, to look for Turner syndrome ^[7]; routine in girls of short stature for French paediatricians ^[2]; the Dutch group reserves it for girls whose height is < -2 SD or more than 1.6 SD below target height ^[1].
Urine dipstick (if kidney disease suspected)if needednon-French guidelineLooking for kidney disease (proteinuria, haematuria, glycosuria): the American Family Physician review cites urinalysis among the tests to request when the clinical picture points to kidney disease (expert opinion, 2015) ^[5], and the 2026 Italian consensus counts it among the tests to do in primary care for any short stature ^[4]. The French paediatricians' baseline tests look for renal failure and tubulopathy with serum creatinine, electrolytes and bicarbonate, without urinalysis ^[2].

Imaging

PA X-ray of the hand and wrist (bone age)

Detailed explanation and international comparison (in French): read it in English (machine translation)

Faltering weight (drop across weight centiles)

Urine tests

Urine microscopy and culture (looking for urinary tract infection)

Laboratory tests (if the child eats gluten)

IgA anti-tissue transglutaminase antibodies (tTG-IgA)
Total IgA measurement

Detailed explanation and international comparison (in French): read it in English (machine translation)

Sources (12)