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A Systematic Review

Patricia G. Wheeler, MD; Karen Bresnahan, MD; Barbara A. Shephard, MD; Joseph Lau, MD; Ethan M. Balk, MD, MPH

Arch Pediatr Adolesc Med. 2004;158:236-243.

Objective  To review the available evidence on the association between primary short stature and intellectual and physical dysfunction among children.

Methods  Systematic searches were performed through October 2001 of English-language studies of children with short stature and functional limitations. Included studies evaluated children with isolated short stature, constitutional growth delay, growth hormone deficiency, or multiple hormone deficiency. Evaluated outcomes included intelligence, academic achievement, visual-motor skills, psychomotor development, and behavior problems.

Results  Eleven studies evaluated academic achievement, and 22 evaluated intelligence. No substantial deviation from normal was seen among short children, but many studies found that children with short stature had significantly lower intelligence and academic achievement scores than controls. Three studies found significant visual-motor skill reduction among short children. One study of psychomotor development found a delay in meeting early developmental landmarks among children with Russell-Silver syndrome. Five studies evaluating teacher-rated behavior found that short children had no more behavior problems than controls.

Conclusions  While, on average, children with short stature score lower than their peers on functional tests, few short children scored outside the normal range. Furthermore, there is no evidence to explain the cause of any deficits, and limited data suggest that treatment of short stature does not improve children's functional status. Nevertheless, treatment may be warranted in children with severe short stature to alleviate restrictions on activities of daily living. Further research focusing on physical limitations due to short stature is needed to address these issues.

From the Divisions of Genetics (Dr Wheeler), Child Development (Dr Bresnahan), Neonatology (Dr Shephard), the Department of Pediatrics, Tufts University School of Medicine, Floating Hospital for Children; and the Tufts–New England Medical Center Evidence-Based Practice Center, Institute for Clinical Research and Health Policy Studies (Drs Lau and Balk), Tufts–New England Medical Center, Boston, Mass.

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