Tall stature is a common reason for consultation of a paediatric endocrinologist. It is important to always consider underlying pathology. We propose a diagnostic flowchart based on five questions. (1) Does the child have tall stature? (2) Is there evidence of a syndrome? (3) Has there been growth acceleration? (4) Are there signs of puberty? (5) Does the child grow within the target height range? Diagnostic tests can then be ordered targeted to the suspected disorder. The Bayley-Pinneau and Tanner-Whitehouse methods are reasonably accurate in predicting adult height based on bone age in girls, but neither method performs well in boys. Tall stature is not a pathological condition and generally does not need treatment. However, adolescents with a strong treatment wish and their parents should be counselled on the effectivity and safety of available treatments including surgery and high-dose sex steroids. Surgical epiphysiodesis has the advantage that a reasonable height reduction can be achieved at a more advanced bone age, allowing a more accurate adult height prediction to base any treatment decision on. We feel that high-dose oestrogen treatment should no longer be used because of its association with reduced fecundity and imminent ovarian failure.