{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T05:11:17Z","timestamp":1782450677909,"version":"3.54.5"},"reference-count":31,"publisher":"American Academy of Pediatrics (AAP)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2011,4,1]]},"abstract":"<jats:sec><jats:title>OBJECTIVE:<\/jats:title><jats:p>To determine if gender is associated with diagnostic evaluation by primary care pediatricians caring for children with growth-faltering.<\/jats:p><\/jats:sec><jats:sec><jats:title>PATIENTS AND METHODS:<\/jats:title><jats:p>This was a retrospective study of children who were attending 4 urban pediatric primary care practices affiliated with a tertiary pediatric hospital. Growth-faltering was defined as height at the &amp;lt;5th percentile or a z-score decrease of \u22651.5 SDs before 18 months of age or \u22651 SD thereafter. For each child, height z score, age, gender, race, insurance, diagnostic tests, and subspecialist appointments were examined.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS:<\/jats:title><jats:p>Of 33 476 children, 3007 had growth-faltering (mean height: \u22121.5 \u00b1 1.0 vs 0.3 \u00b1 0.9 SDs in those without growth-faltering). Boys comprised 53% of the growth-faltering group (vs 51% of the nonfaltering group; P &amp;lt; .01). Among children with growth-faltering, 2.8% had endocrinology appointments (vs 0.8% of others; P &amp;lt; .0001) and 6% had gastroenterology appointments (vs 1.5% of others; P &amp;lt; .0001). Subspecialty care was not associated with gender. Pediatricians ordered diagnostic tests for a significantly greater proportion of children with growth-faltering than others. In multivariate analysis of height z score among children with growth-faltering, tests for chromosomes (1.4% of short girls vs 0.4% of short boys; P &amp;lt; .005) and growth hormone\/insulin-like growth factor axis (0.9% of short girls vs 1.8% of short boys; P &amp;lt; .05) were associated with gender. Thirty-five percent of the girls for whom chromosome testing was performed were 12 years old or older.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS:<\/jats:title><jats:p>Patterns in diagnostic testing of children with growth-faltering by their pediatricians may lead to underdiagnosis of Turner syndrome and growth hormone deficiency among girls.<\/jats:p><\/jats:sec>","DOI":"10.1542\/peds.2010-1563","type":"journal-article","created":{"date-parts":[[2011,3,22]],"date-time":"2011-03-22T04:06:20Z","timestamp":1300766780000},"page":"696-702","source":"Crossref","is-referenced-by-count":34,"title":["Medically Underserved Girls Receive Less Evaluation for Short Stature"],"prefix":"10.1542","volume":"127","author":[{"given":"Adda","family":"Grimberg","sequence":"first","affiliation":[{"name":"Department of Pediatrics,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristen A.","family":"Feemster","sequence":"additional","affiliation":[{"name":"Department of Pediatrics,"},{"name":"Robert Wood Johnson Clinical Scholars Program, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susmita","family":"Pati","sequence":"additional","affiliation":[{"name":"Department of Pediatrics,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Ramos","sequence":"additional","affiliation":[{"name":"Department of Pediatrics,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Grundmeier","sequence":"additional","affiliation":[{"name":"Department of Pediatrics,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew J.","family":"Cucchiara","sequence":"additional","affiliation":[{"name":"Clinical and Translational Research Center and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Virginia A.","family":"Stallings","sequence":"additional","affiliation":[{"name":"Department of Pediatrics,"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2011,4,1]]},"reference":[{"issue":"2","key":"2021121007055492000_B1","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1016\/j.jpeds.2004.09.009","article-title":"Sex differences in patients referred for evaluation of poor growth","volume":"146","author":"Grimberg","year":"2005","journal-title":"J Pediatr"},{"issue":"4","key":"2021121007055492000_B2","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1016\/j.jpeds.2008.10.041","article-title":"Sex-based prevalence of growth faltering in an urban pediatric population","volume":"154","author":"Grimberg","year":"2009","journal-title":"J Pediatr"},{"key":"2021121007055492000_B3","unstructured":"US Department of Health and Human Services. NIH policy and guidelines on the inclusion of women and minorities as subjects in clinical research: amended, October, 2001. Available at: http:\/\/grants.nih.gov\/grants\/funding\/women_min\/guidelines_amended_10_2001.htm. Accessed September 2006"},{"key":"2021121007055492000_B4","volume-title":"Physical Status: The Use and Interpretation of Anthropometry","author":"World Health Organization","year":"1995"},{"key":"2021121007055492000_B5","unstructured":"Centers for Disease Control and Prevention. Cut-offs to define outliers in the 2000 CDC growth charts. Available at: www.cdc.gov\/nccdphp\/dnpa\/growthcharts\/00binaries\/BIV-cutoffs.pdf. Accessed September 2006"},{"key":"2021121007055492000_B6","unstructured":"US Census Bureau. United States Census 2000. Available at: www.census.gov\/main\/www\/cen2000.html. Accessed May 2007"},{"key":"2021121007055492000_B7","unstructured":"US Food and Drug Administration. FDA talk paper: FDA approves Humatrope for short stature. 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