Growth Problems

Key Conditions

Key conditions are the core conditions that the Paediatric Undergraduate and Clerkship Directors of Canada (PUPDOC) felt are essential for graduating medical students to know. The Key Conditions are neither a differential diagnosis nor a clinical approach. They highlight conditions that may be unique to paediatrics, that are essential, or that are common. Key Conditions can present in a number of ways – each is listed as under the most common Clinical Presentation.

Clinical Approach

Clinical approaches represent one of many methods to think through a clinical presentation, and narrow down a differential diagnosis. There are many conditions that can present with similar symptomatology. These presentations are not meant to contain an exhaustive list of differential diagnoses, but rather outline how to think through patient signs and symptoms, and understand some of the most common and important Paediatric conditions. There are many different ways to approach any clinical presentation, and these approaches are not meant to replace clinical judgement.


A 6 year old boy is referred to you due to a history a poor growth. He is below the third percentile in both height and weight



Lecture materials and small group cases are posted here for University of Calgary Cumming School of Medicine students. Access to these materials are password protected.


Small Groups

  • Abnormal Stature Small Group Course 4


Lecture materials and small group cases are posted here for University of Calgary Cumming School of Medicine students. Access to these materials are password protected.


By the end of the Paediatric Clerkship, a medical student will be able to:

  1. Accurately plot and interpret a growth curve.
  2. Clinically recognize familial short stature and constitutional growth delay.
  3. Identify a patient with, and list a differential diagnosis for, failure to thrive and obesity.
  4. Describe the physiological and psychological consequences of obesity and malnutrition.
  5. Recognize that there are specific growth charts for some syndromes with abnormal growth (examples: Turner syndrome, Down syndrome).

Half Day Cases

  • A 7 year old girl presents with short stature. Her parents are concerned that she has always been the smallest in her class. In clinic today, her height is 115 cm and her weight is 20 kg. Her father’s reported height is 175 cm and her mother’s reported height is 155 cm.
  • A 12 year old boy, who is a hockey player, presents with concerns of being short and having no signs of puberty yet. His father remembers having a late growth spurt at age 16 years and is now of average height.
  • A 5 year old girl is referred for poor growth. She has been falling off the curve for both weight and height.
  • An 8 year old boy presents for a routine assessment and is noted to have gained weight since his last visit.
  • A 6 month old girl with Trisomy 21 is referred for poor growth. Height 60 cm and weight 5 kg.
  • An 8 year old girl presents with short stature and a height of 105 cm. The family reports that she has a history of multiple otitis media and learning difficulty in math.


The following resources have been reviewed and collated by canuc-paeds. These resources are aimed to provide information at the level of the medical student. These include overviews of topics, clinical resources, and useful guidelines that contain relevant materials.


  • Failure to thrive: Current clinical concepts. Jaffe AC.
    Pediatrics in Review 2011; 32: 100-108.
    Excellent review on failure to thrive – a common and important paediatric problem. .
  • Short stature in childhood – Challenges and choices. Allen DB et al. .
    NEJM 2013; 368: 1220-1228 .
    This article works through a case and highlights the distinguishing features of familial short stature and constitutional delay – the two most common causes of short stature in children. .


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