Determination of the final body height

General information

For a human being, height is one of his most defining and obvious characteristics. People who are too tall have problems in everyday life, but people who are too small have at least as many problems. But when is a person too big or too small?

are children already too small just because they are the smallest in your school class or too big because all friends are smaller? It is not uncommon for boys to suffer from a completely harmless growth retardation, which is simply compensated for by a late growth spurt. However, it is always important to find out early on whether you are still within a normal range or whether there is a need for action due to a growth disorder.

Treatment at the right time can often enable those affected to lead a normal life with an acceptable body size. However, size is not only important for children who are too big or too small. Growth disturbances must also be taken into consideration in the case of malpositions such as bow legs or bow legs or scoliosis.

In case of leg length differences it is important to know which leg develops normally and which causes the difficulties. However, the current size is not always the determining parameter in the diagnosis of growth disorders. Although this often provides a first clue, the definitive statement can often only be determined by determining the final size of a child.

In order to get an early indication of possible growth disturbances, the determination of body size (bone age determination) is helpful. There is also an important difference in the age of the child. In addition to the biological age (age according to calendar/birthday), the age of the bones (bone age) is very important for the size and growth, since these often differ from each other in the case of growth disorders.

If the skeleton matures too quickly or too slowly, it is simply ahead of its time or is lagging behind and is therefore “younger” or “older” than the child itself is in years. From the age of the calendar, various comparison and norm tables can be used to give initial indications of too fast or too slow growth compared to a comparison group. The standard values for comparison can be found at every pediatrician as a table or diagram.

With children, it is important to look at these norm values very closely, as the relationship between age and size is much more significant, as norm values can vary considerably in very short periods of time, whereas with adults there are hardly any differences to be found, as their size hardly changes any more. If one suspects a disorder here, the next step is usually to determine how large the final size of a child will be and the body length determination (bone age determination) is used. Here there are formulas that include the parental sizes, since large parents are more likely to have large children than smaller parents.

Again, only approximate information can be given, an exact prediction is not possible with certainty. Since knowledge of the final size is ultimately decisive for therapy, bone age determination by means of an X-ray is the method of choice. Although it is not as easy to determine as the biological age or simply calculate with a formula, the more complex diagnostic procedure leads to very accurate and reliable information about the expected final size of a child.

The determination is based on the typical bone changes that every child goes through on its way to adulthood. In children, the so-called growth joints (epiphyseal joints) are found on the bones on the sides between the middle and end pieces. These zones of the bone are made of cartilage and from there the growth of a bone takes place.

The cartilage grows in length and becomes ossified as it progresses. The human being grows. The growth joints eventually ossify even after puberty (usually before the age of 20) and growth comes to a halt, because the bone can only grow from the cartilage in the growth zone.

Responsible for this are an increased amount of the sex hormones testosterone and estrogen in the blood. Most bones in the body are formed in this way from cartilage and ossify at a typical time. Exceptions are a few skull bones, the lower jaw and the collarbone.

The growth joints can now be used to make statements about the current growth status of a child with regard to these special features of bone growth. It is possible to say how long this bone will continue to grow and thus determine the size at which the growth gaps will close and longitudinal growth will be completed.If one compares this additionally with the biological age of the child further statements can be made whether certain diseases (e.g. small stature, large stature, premature puberty (Pubertas precox)) are possible. In principle, the growth joints of any region of the body can be consulted, since each pineal gland ossifies at a typical time.

Due to the high density of many bones and thus of many growth joints, a standard has been developed to assess the X-ray image of the left hand. Rarely, images of the knee are also evaluated. If it is not possible to take an x-ray of the left hand, the right hand can be used with almost identical results. The images taken are then used to assess the carpal bones of the child.