📋 Comprehensive HistoryBirth history (IUGR, prematurity), medications (steroids, ADHD, anticonvulsants), family history of short stature or delayed puberty, nutritional history, chronic illness
🔍 Physical ExaminationBody proportions (upper/lower segment ratio), dysmorphic features, Turner syndrome signs, midline abnormalities, goiter, nutritional status
📈 Serial Growth AssessmentPlot at least 2 measurements over time to calculate growth velocity. A single measurement is insufficient — pattern and trend matter
🪨 Bone Age (if indicated)Left hand/wrist X-ray when short stature is confirmed. Bone age guides IGF-1 interpretation vs bone age, not chronological age