Short stature and poor linear growth — OSCE

Objectives

1. Confirm measurement and chart quality before interpretation. [1]
2. Interpret position, velocity and mid-parental context. [1] [3]
3. Screen for red flags: disproportionate build, poor velocity, systemic signs, psychosocial concern. [1] [4]
4. Counsel without blame and set a clear, safe plan. [1]

Candidate brief

You have 12 minutes. The station provides a growth chart for a 7-year-old boy whose parents are worried he is short. Demonstrate how you would check measurement quality (describe it if no live measurement is possible), interpret the plot, and explain the findings to the caregiver. [1]

Expected actions

• State that you would re-measure height and weight with correct technique, on the chart for the correct age and sex. [1]
• Comment on centile position and whether the channel is parallel or falling — velocity over a single point. [1]
• Ask parental heights and relate the child's height to the mid-parental corridor. [3]
• Screen for disproportionate build (upper-to-lower segment, arm span), dysmorphism, systemic symptoms and psychosocial concern. [1] [4]
• Explain the findings in plain language with teach-back, and agree a plan — observe, investigate, or refer — with a safety-net. [1]

Marking grid

Common fails

• Diagnosing disease from one low point without the serial trend.
• Failing to ask parental heights or measure body proportion.
• Using the wrong chart or uncorrected prematurity.
• Stigmatising language, or promising adult height from the formula alone. [1] [3]