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((refimprove|date=August 2023))
((short description|Height of a human which is below typical))
((Infobox medical condition (new)
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'''Short stature''' refers to a [[height of a human]] which is below typical. Whether a person is considered short depends on the context. Because of the lack of preciseness, there is often disagreement about the degree of shortness that should be called ''short''. [[Dwarfism]] is the condition of being very short, often caused by a medical condition. 

In a medical context, short stature is typically defined as an adult height that is more than two [[standard deviation]]s below a population’s [[mean (statistics)|mean]] for age and sex, which corresponds to the shortest 2.3% of individuals in that population.<ref>((cite journal |vauthors=Pedicelli S, Peschiaroli E, Violi E, Cianfarani S |title=Controversies in the definition and treatment of idiopathic short stature (ISS) |journal=J Clin Res Pediatr Endocrinol |volume=1 |issue=3 |pages=105–15 |year=2009 |pmid=21274395 |pmc=3005647 |doi=10.4008/jcrpe.v1i3.53 ))</ref> 

In [[popular culture]], the [[Napoleon complex]], also known as "Napoleon syndrome" and "short man syndrome", is a purported condition normally attributed to people of short stature, with overly aggressive or domineering social behavior, and is named after [[Napoleon Bonaparte]], the first [[Emperor of the French]], who was estimated to have been 5' 2" tall (in pre–metric system French measures), which equals around 1.67 meters, or just under 5' 6" in [[imperial measure]].<ref>https://www.history.com/news/napoleon-complex-short</ref>

==Causes==
Shortness in children and young adults nearly always results from below-average [[Human development (biology)|growth]] in childhood, while shortness in older adults usually results from loss of height due to [[kyphosis]] of the [[vertebral column|spine]] or collapsed [[vertebra]]e from [[osteoporosis]]. The most common causes of short stature in childhood are [[constitutional growth delay]]  or familial short stature. ((citation needed|date=January 2024))

From a medical perspective, severe shortness can be a [[human variability|variation]] of normal, resulting from the interplay of multiple familial genes. It can also be due to one or more of many abnormal conditions, such as chronic (prolonged) [[growth hormone]] or [[thyroid hormone]] deficiency, [[malnutrition]], disease of a major organ system, mistreatment, treatment with certain drugs, [[chromosome|chromosomal]] deletions. [[Human growth hormone]] (HGH) deficiency may occur at any time during infancy or childhood, with the most obvious sign being a noticeable slowing of growth. The deficiency may be genetic. Among children without [[growth hormone deficiency]], short stature may be caused by [[Turner syndrome]] or [[Noonan syndrome]], [[chronic kidney disease]], being [[small for gestational age]] at birth, [[Prader–Willi syndrome]], [[Wiedemann-Steiner syndrome]], or other conditions. Genetic [[skeletal dysplasias]] also known as [[osteochondrodysplasia]] usually manifest in short-limbed disproportionate short stature.<ref name=gamal2017/><ref name=Panda2014/>

When the cause is unknown, it is called ''[[idiopathic short stature]]''.<ref name=Allen>((cite journal |author=Allen DB |title=Growth hormone therapy for short stature: is the benefit worth the burden? |journal=Pediatrics |volume=118 |issue=1 |pages=343–8 |date=July 2006 |pmid=16818584 |doi=10.1542/peds.2006-0329 |s2cid=10045158 ))</ref>
Short stature can also be caused by the bone plates fusing at an earlier age than normal, therefore stunting growth. Normally, the [[bone age]] is the same as the biological age but for some people, it is older. For many people with advanced bone ages, they hit a growth spurt early on which propels them to average height but stop growing at an earlier age. However, in some cases, people who are naturally shorter combined with their advanced bone age, end up being even shorter than the height they normally would have been because of their stunted growth.

Some of the reasons growth development may slow include:
* Genetics. When a child’s parents and grandparents are short, the child may also be short; this is known as familial short stature. Also, the target height is merely an estimate and some children simply don't grow as tall as expected.
* Genetic conditions. Several genetic syndromes can lead to short stature, including [[Prader–Willi syndrome|Prader-Willi syndrome]], [[Turner syndrome]] and Noonan syndrome.
* Chronic diseases. Growth hormone is produced by the pituitary gland, located in the middle of the brain. Therefore, chronic medical problems that affect the pituitary gland may also affect growth. For example, radiation to the brain can affect pituitary function, so pediatric cancer or its treatment can lead to short stature. Gastrointestinal diseases that impair nutrition, such as inflammatory bowel disease and celiac can affect growth, can also be a cause. Many other conditions can also delay the growth rate, including [[hypothyroidism]], heart disease, kidney disease, immunological disease and several other endocrine disorders.
* [[Growth hormone deficiency]]. Some children simply don't produce enough growth hormone, including those born with a poorly developed [[pituitary gland]].
* Malnutrition. This is caused by an inadequate food supply, an eating disorder, or an underlying condition or treatment that affects appetite, lack of nourishment is a common cause of growth delay.
* Psychosocial stress. Exposure to violence because of war or famine or just being in a home environment that’s not very nurturing, children can also experience a [[Psychosocial hazard|psychosocial stress]] that keeps them from growing properly,” Dr. Patel says. “That can be reversed just by removing them from the stressful environment.”<ref>((Cite web |title=Short Stature (Growth Disorders) in Children |url=https://www.yalemedicine.org/conditions/short-stature-child |access-date=2022-07-02 |website=Yale Medicine |language=en))</ref>

==Classification==
Chronic illnesses, malnutrition, endocrine, metabolic disorders or chromosomal anomalies are characterized by proportionate short stature.
On the other hand, most genetic [[skeletal dysplasias]] are known for short stature that may be proportionate or disproportionate. Disproportionate short stature can be further subdivided as specified by the body segments affected by shortening, namely limbs versus trunk:<ref name=gamal2017>((cite journal|doi=10.1016/j.ejrnm.2016.10.007|title=Pseudoachondroplasia in a child: The role of anthropometric measurements and skeletal imaging in differential diagnosis|journal=The Egyptian Journal of Radiology and Nuclear Medicine|volume=48|pages=245–250|year=2017|last1=Gamal|first1=Radwa|last2=Elsayed|first2=Solaf M.|last3=El-Sobky|first3=Tamer Ahmed|last4=Elabd|first4=Heba Salah|doi-access=free))</ref><ref name=Panda2014>((cite journal | doi=10.4329/wjr.v6.i10.808 | doi-access=free | title=Skeletal dysplasias: A radiographic approach and review of common non-lethal skeletal dysplasias | date=2014 | last1=Panda | first1=Ananya | last2=Gamanagatti | first2=S. | last3=Jana | first3=M. | last4=Gupta | first4=A. K. | journal=World Journal of Radiology | volume=6 | issue=10 | pages=808–825 | pmid=25349664 | pmc=4209426 ))</ref>
* Short-limb short stature in which there is limb shortening as [[achondroplasia]], hypochondroplasia, pseudoachondroplasia and multiple epiphyseal dysplasia.
* Short-trunk short stature in which there is trunk shortening as spondyloepiphyseal dysplasia and mucopolysaccharidosis.
Short-limb short stature can be further subcategorised in accordance with limb segment affected by shortening. These subcategories of limb shortening include, rhizomelic (humerus and femur), mesomelic (radius, ulna, tibia and fibula) and acromelic (hands and feet). Anthropometric measurements provide are very beneficial tools to the diagnostic process of genetic [[skeletal dysplasias]]. The anthropometric measurements include height, sitting height, arm span, upper/ lower-body segment ratio, sitting height/height ratio, and arm span/height ratio for age. They also aid in the differential diagnosis of [[skeletal dysplasia]] subtypes.<ref name= gamal2017/>

==Treatment==
The decision to treat is based on a belief that the child will be disabled by being extremely short as an adult, so that the risks of treatment (including sudden death<ref name=Allen />) will outweigh the risks of not treating the [[symptom]] of short stature. Although short children commonly report being teased about their height, most adults who are very short are not physically or psychologically disabled by their height.<ref name=Allen /> However, there is some evidence to suggest that there is an inverse linear relationship with height and with risk of suicide.<ref name="psychiatry online Strong Inverse Association Between Height and Suicide">((cite journal |url=http://ajp.psychiatryonline.org/Mobile/article.aspx?articleid=177657|title=Psychiatry Online Strong Inverse Association Between Height and Suicide in a Large Cohort of Swedish Men: Evidence of Early Life Origins of Suicidal Behavior? |journal=American Journal of Psychiatry |date=July 2005 |volume=162 |issue=7 |pages=1373–1375 |doi=10.1176/appi.ajp.162.7.1373 |access-date=2014-02-25 |last1=Magnusson |first1=Patrik K. E. |last2=Gunnell |first2=David |last3=Tynelius |first3=Per |last4=Davey Smith |first4=George |last5=Rasmussen |first5=Finn |pmid=15994722 ))</ref>

Treatment is expensive and requires many years of injections with human growth hormones. The result depends on the cause, but is typically an increase in final height of about ((convert|5|to|10|cm|in)) taller than predicted.<ref name=Allen /> Thus, treatment takes a child who is expected to be much shorter than a typical adult and produces an adult who is still obviously shorter than average. For example, several years of successful treatment in a girl who is predicted to be ((Convert|146|cm|ftin)) as an adult may result in her being ((Convert|151|cm|ftin)) instead. ((citation needed|date=January 2024))

Increasing final height in children with short stature may be beneficial and could enhance health-related quality of life outcomes, barring troublesome side effects and excessive cost of treatments.<ref name="urlHeight and Health-related Quality of Life">((cite web |url=http://gghjournal.com/volume24/1/ab09.cfm |title=Height and Health-related Quality of Life ))</ref>((dead-link|date=February 2023))

===Cost===
The cost of treatment depends on the amount of growth hormone given, which in turn depends on the child's weight and age. One year's worth of drugs normally costs about US$20,000 for a small child and over $50,000 for a teenager.<ref name=Allen /> These drugs are normally taken for five or more years.((fact|date=August 2023))

==Cultural, social and economic issues==
From a social perspective shortness can be a problem independently of the cause. In many societies there are advantages associated with taller stature and disadvantages associated with shorter stature, and vice versa.((fact|date=August 2023))

===Height discrimination===
People of shorter stature can be victims of [[height discrimination]]. Height discrimination, particularly as regards men, has been documented in lower wages and achievement for shorter men, and as a handicap when it comes to perceived attractiveness by women.((fact|date=August 2023))

===Short stature as a disease===
Pharmaceutical companies [[Genentech]] and [[Eli Lilly and Company|Eli Lilly]], makers of human growth hormone, have worked to [[medicalize]] short stature by convincing the public that short stature is a [[disease]] rather than a natural variation in human height. Limiting sales of the hormone to children diagnosed with [[growth hormone deficiency]], rather than being short for any reason, limited their sales market.<ref name=Brody>((cite book| author = Brody, Howard| title = Hooked: ethics, the medical profession, and the pharmaceutical industry| publisher = Rowman & Littlefield| location = Lanham, Md| year = 2007| page = [https://archive.org/details/isbn_9780742552180/page/236 236]| isbn = 978-0-7425-5218-0| url-access = registration| url = https://archive.org/details/isbn_9780742552180/page/236))</ref> Expanding it to all children whose height was below the third percentile would create 90,000 new customers and US$10 billion in revenue.<ref name=Valenstein>((cite book| author = Valenstein, Elliot S.| title = Blaming the Brain : The Truth About Drugs and Mental Health| publisher = Free Press| location = New York| year = 2002| pages = 173–174| isbn = 978-0-7432-3787-1))</ref> In the early 1990s, they paid two US charities, the Human Growth Foundation and the [[MAGIC Foundation]], to measure the height of thousands of American children in schools and public places, and to send letters urging medical consultations for children whose height was deemed low. Parents and schools were not told that the charities were being paid by the drug companies to do this.<ref name=Brody/><ref name=Valenstein/>

Paired with a campaign to advertise the hormone to physicians, the campaign was successful, and tens of thousands of children began receiving HGH. About half of them do not have [[growth hormone deficiency]], and consequently benefited very little, if at all, from the hormone injections. Criticism of the [[universal screening]] program eventually resulted in its end.<ref name=Valenstein/>

==Advantage==
Short stature decreases the risk of [[Chronic venous insufficiency|venous insufficiency]].<ref>((cite web |title=Tall height |url=https://www.nlm.nih.gov/medlineplus/ency/article/000203.htm))</ref>

==History==
During [[World War I]] in Britain, the minimum height for soldiers was ((convert|5|ft|3|in|cm)). Thus thousands of men under this height were denied the opportunity to fight in the war. As a result of pressure to allow them entry, special "[[Bantam (military)|Bantam Battalions]]" were created composed of men who were ((convert|4|ft|10|in|cm)) to ((convert|5|ft|3|in|cm)). By the end of the war there were 29 Bantam Battalions of about 1,000 men each. Officers were of normal size.<ref>((cite news |url=https://www.bbc.com/news/magazine-31023270 |title=Bantams: The army units for those under 5ft 3in  |work=BBC News Magazine |author=Tom de Castella |date=8 February 2015 |access-date=February 9, 2015))</ref>

== See also ==
* [[Dwarfism]]
* [[List of shortest people]]
* [[National Organization of Short Statured Adults]]
* [[Primordial dwarfism]]
* [[Psychosocial short stature]]—growth inhibition caused by extreme stress
* [[Pygmy]]

==References==
<references />

== External links ==
((Medical resources
|   DiseasesDB     = 18756
|   ICD10          = ((ICD10|E|34|3|e|20))
|   ICD9           = ((ICD9|783.43))
|   ICDO           =
|   OMIM           =
|   MedlinePlus    = 003271
|   eMedicineSubj  = ped
|   eMedicineTopic = 2087
|   MeshID         =
))
((Growth disorder))
((Nutritional pathology))

[[Category:Human height]]
[[Category:Symptoms and signs]]

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