Determination of the final height

General

Height is one of the most defining and obvious characteristics of a person.
People who are too big have problems in everyday life, but too small at least as much. 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 one completely harmless growth retardationgoing through a late Growth spurt just balance.
However, it is always important to find out early on whether you are still in one Normal range moved or whether Need for action because of a stunted growth. Treatment at the right time can often enable those affected to lead a normal life with an acceptable height.

However, size is not only important for children who are too big or too small. Also at Misalignments how Knock knees or bow legs or one Scoliosis have to Stunted growth be considered.
At Leg length differences it is important to know which leg is developing normally and which is causing the difficulty. However, that is not always the case current size the determining one parameter in the diagnosis of growth disorders. This often provides a first reference point, the definitive statement can often only be made through the Determination of the final size determine a child.

Read our page for more information Development of the child.

Determination of bone age

In order to get an early indication of possible growth disorders, the body size determination (Determination of bone age) helpful.
There is also an important difference to note when it comes to the age of the child. In addition to biological age (Age according to calendar / birthday) is for the size and growth namely the age of the bones (Bone age) very important, as these often differ from one another in growth disorders.
If the skeleton matures too quickly or too slowly, then it is simply ahead of its time or lags behind and is therefore “younger” or “older” than the child itself is in years.

From the calendar age, various comparison and norm tables can be used to provide initial clues about growth that is too fast or too slow compared to a comparison group.
The standard values ​​for comparison can be found at every pediatrician as a table or graph.
In children, it is important to look at these normal values ​​very carefully, as the relationship between age and height is much more important, as the normal values ​​can differ considerably in very short periods of time, while in adults there are hardly any differences to be found, since his size is indeed different hardly changed anymore.
If you suspect a disorder here, the next step is usually to determine how big the final height of a child will be and to determine the body length (Determination of bone age) comes to your use.
There are formulas here that take parent sizes into account, as large parents are more likely to have large children than smaller parents.
Here, too, 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, determining the bone age using an X-ray image is the method of choice. Although it is not as easy to determine as biological age or simply to calculate it with a formula, the more complex diagnostics lead to very precise and reliable information about the probable final height of a child.

Determination of bone age by x-rays

The determination makes use of the typical changes in the bones that every child goes through on their way of growing up.
In children, the so-called growth plates are found on the bones on the sides between the middle and end pieces (Epiphyseal plates).
These zones of the bone are made up of cartilage and it is from there that bone growth takes place. The cartilage grows in length and becomes ossified as it progresses. Man grows.
The growth plates eventually ossify even after puberty (mostly before the age of 20) and growth comes to a standstill, because the bone can only grow from the cartilage of the growth zone.
This is due to an increased amount of the sex hormones testosterone and estrogen in the blood.
Most of the bones in the body are made up of cartilage in this way and ossify at a typical point in time. Exceptions are a few skull bones, the lower jaw and the collarbone.

Using the growth plates, statements about the current growth status of a child can now be made about these particularities in bone growth. You can say how long this bone will continue to grow and thus determine the size with which the growth plates will close and the length growth will be completed. If you compare this with the biological age of the child, further statements can be made as to whether certain diseases (e.g. short stature, tall stature, premature puberty (Precoxious puberty)) come into question.

In principle, the growth plates of any region of the body can be consulted, as each epiphysis ossifies at a typical point in time. Due to the high density of many bones and thus many growth plates, a standard was developed in which the X-ray image of the left hand is assessed. Images of the knee are also rarely assessed. If the left hand cannot be captured, the right hand can also be used with almost the same results. The carpal bones of the child are then assessed on the images made.

Also read our topic: X-ray examination of the child

Determination of bone age with the help of the carpal bones

The carpal bones are that 8 small bones which one on Palms feel can.
In the male infant, all these bones are still made of cartilage at birth, which then ossify as they develop. A female baby is born with 2 ossified carpal bones.
The complete ossification this cartilage is made after a whole specific pattern and orderwhich is comparable for every person.

There cartilage in the X-ray not visible are so in the course of development more and more carpal bones appear in the X-ray image up to the age of 14 years (girl) or 16 years (Boys) the Carpal bones all seen are.
So one can use the growth plates and the number of visible bones Conclusions to the state of Skeletal development pull. Several doctors and scientists have found the typical ossification on this basis standardized procedures developed based on which today Skeletal age is determined and the Final sizing can be carried out, whereby only the 2 best-known methods are described here.

According to the principle of Greulich and Pyle the X-ray image with images in an atlas is using Comparison recordings matched.
The two have in an atlas X-rays sorted by age and gender collected and the Maturity mark which can be seen on it. This can be done using the images that are most similar to the description and X-ray of the child Skeletal age and the State of growth be determined and statements about the Final height be made.
Statements can also be made as to whether Growth spurts are to be expected or whether the growth is almost complete.
A little more differentiated and in Germany used more often is the method according to Tanner and Whitehouse. Here will be multiple images used and Point values forgive.
In addition to the carpal bones, the Cubit and spoke (The two bones of the forearm), as well as selected Metacarpal bones (Palpable long bones above the heel of the hand) and Phalanges included. The age of the bones can then be read from a table based on the point value.

application areas

Both methods can however just apply if it can be ensured beforehand that the Bone formation of the child not bothered because the comparative values ​​and norms all come from children with normal, healthy bone growth and can of course only be compared with those of normal, healthy children.

You now have the State of growth of the skeleton, statements can be made when a correction is best is possible.
With children that are too small, for example, you can determine whether they are still with you Growth spurt is to be expected or not. You can face stressful so many times Spared hormone treatments when it is clear that they will still grow naturally.
Also at to big kids one can determine by predicting possible growth spurts whether a Treatment to slow down growth is really necessary. This is often only necessary if a growth spurt is to be expected.
However, if the growth plates are already closed, the laborious treatment is no longer of any benefit to the children. It will stop growing even without the treatment.