1. Background and purpose

Growth is one of the core characteristics of childhood. Recently, due to improved socio-economic development and a westernised diet, the average height in Korean children has increased. This has shifted the social atmosphere to favour taller heights and has increased global interest in promoting height growth.
A growing number of children are visiting Korean medical institutions to receive growth treatment for height growth, and the medical expenses for Korean medical treatment for growth disorders have also become significant. Thus, it is necessary to develop clinical practice guidelines (CPGs) for South Korea to provide safe and effective medical services to reduce the burden on the social and economic sectors. However, there are no CPGs for growth disorders in Korean children and adolescents.
CPGs from the United States are limited to children with growth hormone deficiency and infants who are small for gestational age. CPGs from China are limited to growth hormone treatment. Therefore, currently available CPGs may not be reflective and applicable to patients visiting Korea for the management of growth disorders and the innovative medical environment.
We aimed to develop a Korean CPG for the medical management of growth disorders in children and adolescents through the collection and analysis of currently available evidence and literature.

2. Overview of disease

Growth disorders in children and adolescents, particularly short stature, are characterised by poor height growth with an annual growth rate velocity of less than 4cm or height that is below the 25th percentile of standard growth charts for age and sex. In addition, growth disorders should be suspected when the height is two standard deviations less than the average standard growth charts for age and sex or below the third percentile.
Height percentiles are measurements that indicate a child’s height compared to other children according to a standardized growth chart. If a child is in the tenth percentile, it means that 10% of age-matched children are shorter and 90% of children are taller. Currently, the diagnosis and insurance coverage for short stature is determined based on a height below the third percentile in Korea.
Growth disorders can be divided into (1) primary growth disorders, which are caused by internal defects in the growth plates; (2) secondary disorders, which are secondary to chronic or endocrine diseases; and (3) idiopathic growth disorders, which are not secondary to any specific cause. In addition, precocious puberty, which can cause short stature through the premature closure of growth plates, is also considered a major cause of growth disorders.
Patients with growth hormone deficiency are generally classified under idiopathic growth hormone deficiency (KCD code: E230). In the case of idiopathic short stature, they are classified as short stature not otherwise specified (KCD code: E343), a lack of expected normal physiological development (KCD code: R628), and other disorders of bone development and growth (KCD code: M892).
In Korean medicine, children are considered to have “weak lungs, spleen, and kidneys.” Based on this, the goal of treatment is to adjust the condition of the whole body, including the endocrine, digestive, and respiratory system to treat the causes of impaired childhood growth.
The growth disorders covered in this CPG are as follows: (1) idiopathic short stature, (2) growth disorders with normal height range above the third percentile;
and (3) growth disorder with precocious puberty.