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Short Stature Referral Access Criteria

Short Stature Referral Access Criteria

Referrers should use this page when referring patients to public paediatric endocrinology and diabetes outpatient services for short stature. This RAC is applicable to referrals for patients aged <16 years only.
Emergency referral
If any of the following are present or suspected, refer the patient to the emergency department or seek emergency medical advice if in a remote region.
  • Nil
Immediate referral
Orange exclamation mark in triangle: orange alertImmediately contact on-call registrar or service to arrange immediate paediatric endocrinology assessment (seen within 7 days):
  • Nil

To contact the relevant service, see Clinician Assist WA: Acute Paediatric Assessment (external site)
Clinical indications for outpatient referral
If any of these issues are present, refer to outpatient services through the Central Referral Service (CRS).
  • Faltering height despite receiving adequate nutrition (including no gastrointestinal symptoms)
  • Crossing percentiles on repeated growth measurements
  • Current height less than first percentile for age
Mandatory information
Referrals missing 'mandatory information' with no explanation provided may not be accepted by site. If 'mandatory information' is not included, the explanation must be provided in the body of the referral (e.g. patient unable to access test in regional or remote areas or due to financial reason).

This information is required to inform accurate and timely triage. If unable to attach reports, please include relevant information/findings in the body of the referral and advise where (provider) investigation/imaging was completed.
History
  • Familial history of height, weight and onset of puberty
  • Current medication list
  • Any known allergies
Examination
  • Nil
Investigations
  • Serial measurements of height and weight for a minimum of 6-12 months in a growth chart
  • Staging of puberty (delayed/arrested/pre-pubertal)
Highly desirable
History
  • Nil
Examination
  • Nil
Investigations
  • Insulin-like growth factor 1 (IGF-1)
  • Insulin-like growth factor binding protein 3 (IGF-BP3)
  • TSH, free T4
  • FBC
  • U&E
  • Urinalysis
  • Coeliac screening (anti-tissue transglutaminase – IgA and IgG)
  • X-ray left hand for bone age if >2 years of age – see ‘Exclusions’ for condition
  • For females: consider karyotype (for Turner Syndrome)
Indicative clinical urgency category

Category 1

Appointment within 30 days

  • No defined category 1 criteria

Category 2

Appointment within 90 days

  • Current height less than 1st percentile for age
  • Crossing percentiles on repeated growth measurements

Category 3

Appointment within 365 days

  • Variants of normal growth including familial short stature
Exclusions
  • Refer to general paediatrics if height centile consistently above the 1st centile and no crossing of centiles is present.
  • Refer to general paediatrics if weight is decreasing more than length/height.
  • If bone age-analysis shows fused growth plates (aged >13.5 years in females or aged >15.5 years in males). There are no treatment options to increase height once growth plates are fused.
Useful information

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Last reviewed: 18-03-2024
wa.gov.au