Abnormal growth


  • Normal growth rate along centile predicted by parental height
  • Age appropriate pubertal stage
  • No symptoms of raised intracranial pressure
  • No symptoms of diabetes insipidus
  • No risk factors for a brain tumour
  • Normal neurological examination


  • Growth rate slower than normal (height and/or weight falling away from centiles or small for family height) Or
  • Growth rate slower than normal AND pubertal stage inappropriate for age


  • Growth rate slower than normal (height or weight falling away from centiles or small for family height)
  • Symptoms of raised intracranial pressure
  • Symptoms of diabetes insipidus
  • Abnormal neurological examination

Diagnostic pitfalls

  • Delayed diagnosis associated with not considering a CNS cause of growth failure with vomiting


  • Determine how long patient/parents/carers have had concerns about growth
  • Ask specifically about eating patterns and behavior
  • Plot height and weight on growth chart and compare with previous measurements
  • Plot head circumference in children under two
  • Measure and plot parental heights and calculate predicted height
  • Ask specifically about associated symptoms and risk factors:
    • Personal or family history of a brain tumour
    • Leukaemia
    • Sarcoma and early onset breast or bowel cancer prior therapeutic CNS irritation
    • Neurofibromatosis types 1 and 2
    • Tuberous Sclerosis
    • Li Fraumeni Syndrome
    • Family history of colorectal polyposis
    • Gorlins Syndrome
    • Other familial genetic syndromes
  • Determine pubertal status
  • Neurological examination (include assessment of vision (including acuity), gait and coordination)
  • Full visual assessment - especially looking for loss of upward gaze