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Many of you know about our issues with my kids being small. My eldest is 14 and was below the growth chart until she was 12. She finally started shooting up at that age and is now 5'4" (I'm only 5'2", hubby is 5'6"). However, they've given me a really hard time about my son's size. We did a bone age test the other day which showed delayed growth (as expected) and that his growth was at 4.5 years. But the doctor still wants to do a bunch more tests. Does anyone have any experience with this stuff?

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DD had a bone scan for the opposite reason (growing too fast). They take an xray of the hand to determine how many bones have calcified. (Particular bones don't show up on the xray until they calcify at certain ages.) My dd showed she was about 1.5 years ahead of normal growth, yours might show your ds is behind.

 

I am no doctor, but maybe if they can give him some growth hormone, he can grow before the bones calcify? In our case, they've taken one xray and want to take another, and then they probably won't do much of anything.

 

Hope that helps!

Susan

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When I was 15, I had to get a bone age test. It showed I was at 10 years.

 

I have hypothyroidism and had been on meds for a few years by then but they were still worried because I was so small. We did no further testing, assuming I would either grow at some point or just be small.

 

I am happy to say that I am now just shy of 5'6". :) (2 of those inches were added after I was 18)

 

I hope everything turns out for you guys. It sounds like he is just small now and will surely catch up, just as his sister did.

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DD had a bone scan for the opposite reason (growing too fast). They take an xray of the hand to determine how many bones have calcified. (Particular bones don't show up on the xray until they calcify at certain ages.) My dd showed she was about 1.5 years ahead of normal growth, yours might show your ds is behind.

 

Right, it showed 4.5 years and he'll be nine in April. So, it is way behind.

 

I am no doctor, but maybe if they can give him some growth hormone, he can grow before the bones calcify? In our case, they've taken one xray and want to take another, and then they probably won't do much of anything.

 

 

Hm, I don't know. I guess we'll find out more after we see the endocrinologist. I know both dh and I were late bloomers. I didn't start my period until I was 15, so, I was always tiny but kept growing (some, I'm still only 5'2") after my peers.

 

When I was 15, I had to get a bone age test. It showed I was at 10 years.

 

I have hypothyroidism and had been on meds for a few years by then but they were still worried because I was so small. We did no further testing, assuming I would either grow at some point or just be small.

 

I am happy to say that I am now just shy of 5'6". :) (2 of those inches were added after I was 18)

 

I hope everything turns out for you guys. It sounds like he is just small now and will surely catch up, just as his sister did.

 

Thanks, that's what I'm thinking. It's just hard when doctors want everyone to be average, kwim?

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My son Tanner is 14 and has been on growth hormone shots since he was 10. We went through all the requested tests and it showed that his body created the growth hormone it just did obsorb it.

 

I fought with our Ped about his height when he was 10 and finally had a body age scan which showed his bone age at 6.5. We had been measuring him every month for a year before we went to the Ped and he had only grown a 1/4 inch in a year. He is 14 now and still just hit 5'1.

 

I am not short (5 ft 6) and his father is 5 ft 9. His endocrinologist says he should be 5ft 10 when all is said and done.

 

One question for you: Is you Ped asking for more tests to be done or is the endocrinologist? if it is the endo then most likely it is to satisfy the insurance company because they DO NOT want to pay for growth hormone!

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One question for you: Is you Ped asking for more tests to be done or is the endocrinologist? if it is the endo then most likely it is to satisfy the insurance company because they DO NOT want to pay for growth hormone!

 

We are military and he is being seen at a military facility. So, there's no insurance company to haggle with. My son has a lung disorder and regularly sees a pediatric pulminologist. The pulminologist ordered the bone age scan and is referring us over to the endocrinologist.

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Several years' experience by now, with two children.

 

I'll assume that you are working with a pediatric endocrinologist.

 

We have not had any testing other than bone ages and bloodwork.

 

What is your doctor recommending for tests, and what does s/he suspect might be the helpful information?

 

I just called out to my husband to ask about the math formula for boys. He says that, to predict the mean height for a boy, do this:

(1) Take the mother's height in inches, and add 6. (In your case, then, 62 + 6 = 68)

(2) Average the result of step 1 with the father's height in inches (In your case, your dh is 66 inches tall.).

(3) Your son, then, would be predicted to reach 67 inches -- the mean target height for him. (I'm using "mean" in the mathematics sense.)

 

HOWEVER: Something appears to be "going on" with your son's growth. The endocrinologist will use the results of the bone age readings, and the results of any other testing, to "plug into" a different, more complex set of calculations, in order to predict the height attainable by your son.

 

For example, in my son's case, the formula for a "normal" boy would predict his mean target height to be 5'9". In his actual case, the doctor has calculated that he may hope to reach 5'5" (maybe it is 5'6" -- dh and I are squabbling over this as I type). At any rate, our son currently is 5'2", and will turn 16 years old in mid-April.

 

That depletes my knowledge pool. If I can help with anything else, I'll gladly try !

 

Antonia

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We are military and he is being seen at a military facility. So, there's no insurance company to haggle with. My son has a lung disorder and regularly sees a pediatric pulminologist. The pulminologist ordered the bone age scan and is referring us over to the endocrinologist.

 

There was a fairly recent thread regarding this issue with growth hormones. Several people had first hand experience, also research as much as you can what this really means, possible side effects, etc.

 

What is wrong with being smaller than average? There are a lot of people taller than average and nobody squawks about that much. I have an aunt who is not even 5 feet tall. She is perfectly healthy and 85 yrs of age.

If your ds is healthy otherwise and you know that you, as well as your dd, grew later on, why are the physicians worried about this now?

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Could it be they want to do more tests because of the meds he's on for his lung problems? My dd has some lung / breathing issues and they've kept a close eye on her growth when she's on certain meds. She's tiny but they haven't been concerned enough to do any tests. Just a thought. I hope everything works out.

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What is wrong with being smaller than average?

 

Nothing, IMO. :D

 

If your ds is healthy otherwise and you know that you, as well as your dd, grew later on, why are the physicians worried about this now?

 

That's what I'd like to know.

 

Could it be they want to do more tests because of the meds he's on for his lung problems? My dd has some lung / breathing issues and they've kept a close eye on her growth when she's on certain meds. She's tiny but they haven't been concerned enough to do any tests. Just a thought. I hope everything works out.

 

I asked the pulminologist about this and he said, if anything, the meds he is on would cause him to be bigger, not smaller.

 

Thanks for sharing your thoughts and experiences, everyone. :)

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What is wrong with being smaller than average?

 

From what I understand, not growing can be a signal of other physical problems. Our physicians wanted to rule out any other issues, not just stature.

 

Mungo....our ds will be nine in July and his bone age is 6.5. His endo wants him to have a bone age test every 6 months. Our ds is on advair, prn, and the endo wants him off asap because it can hinder growth. I've read different reports on that, but.....

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When I was 15, I had to get a bone age test. It showed I was at 10 years.

 

I have hypothyroidism and had been on meds for a few years by then but they were still worried because I was so small. We did no further testing, assuming I would either grow at some point or just be small.

 

I am happy to say that I am now just shy of 5'6". :) (2 of those inches were added after I was 18)

 

I hope everything turns out for you guys. It sounds like he is just small now and will surely catch up, just as his sister did.

 

I agree about the shoot up after 18, thats when I grew from under five feet to five foot four.

 

I had all kinds of tests, but that was in the seventies, did they have xrays than?

 

They said I was three years behind. But, I caught up, no worries. My oldest is short, but I keep telling her dont worry til you're 21.

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From what I understand, not growing can be a signal of other physical problems. Our physicians wanted to rule out any other issues, not just stature.

 

Mungo....our ds will be nine in July and his bone age is 6.5. His endo wants him to have a bone age test every 6 months. Our ds is on advair, prn, and the endo wants him off asap because it can hinder growth. I've read different reports on that, but.....

 

My son is on advair and a chronic zithromax. That's interesting.

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A little bit of experience -- but sort of where you are now. We had dd's bone age checked for the first time just before she turned six. It came back as about two years delayed, *but* the delayed age matched up pretty closely with her actual height at the time. Meaning, *if* she had been turning 4 (not turning 6), she was percentage-wise about where they would expect her to be given dh and my heights (not tall). The doctor said this was exactly what he *wanted* to see, since it was pretty much exactly the pattern of "constitutional growth delay" (not a syndrome, just a variation of normal growth pattern -- late bloomer).

 

Most kids who follow a CGD pattern lose most of their ground on the charts in the preschool years, roughly 3-5, and then continue to grow at an average *rate*, but a few years behind their age-mates. However, their age-mates hit their puberty growth spurts, hit adult height, and stop growing. Kids with CGD just keep on at a kid-growth rate and don't hit their puberty growth spurt or puberty changes for a few more years, at which they finally do (2-4 years behind peers, usually) and reach their adult height. (Their adult heights are usually small, but within normal range.)

 

Anyway, our pediatrician felt that since dd's growth and her bone-age *matched*, and she showed no other developmental problems, we shouldn't be too worried. He offered to send her to a pediatric endocrinologist, but said that if it were his child, he wouldn't at this time. We're continuing to monitor her growth.

 

Her most recent bone age was taken just before turning eight. She's now showing about three years behind in bone age, but she has continued to grow during that time...

 

The one thing that concerns me a little in our case is the thing that I would find reassuring in yours. In most cases, kids with CGD have a parent (or parents) who were also "late bloomers" and grew later. While neither dh nor I are tall, neither of us grew late either. Your family pattern is more usual.

 

I haven't absolutely ruled out taking dd to a pediatric endocrinologist. I also worry a little bit about whether there's some underlying condition causing her not to grow... But in those cases, it likely wouldn't effect her bone age all that much (which is part of why our ped found the delayed bone age *reassuring*). She's also not showing any signs of malnutrition or heart problems or developmental delays. She's just *tiny*!

 

http://www.magicfoundation.org/www/docs/11.1067/constitutional--late-growth-bloomer.html

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I would go ahead with the basic tests. They will likely also check thyroid which is very easy to treat. I am sure they want to rule out any other causes behind the delayed growth. It is easier to treat it before puberty starts than after.

 

Our endo just saw my girls every 6 months and did bone age and blood tests. My 14dd has been on thyroid meds for 7 years now. We were very on the fence about growth hormone for her but by watching her closely over time (your doctor might want to be getting some baselines on your son) the doctor thought she would reach 4'10" and we decided not to do the growth hormones. Right now she is 4'9" and has gone through her growth spurt and hasn't grown in over a year. This might be as tall as she gets.

 

I would say for a girl 4'10 is about as small as I would want to go--5' would be even better. For a boy though, it is harder to be small. Short men do really stand out---at least in our area where most of the population is at the 75% or more.

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My son is on advair....

 

Yeah, that would concern me. My ds takes Advair, but I would avoid it with dd since it *can* cause growth delays. (As I understand it, children typically catch back up to where they were expected to be when the Advair is discontinued -- but it would still make me nervous with a child for whom growth as already an issue.)

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Yeah, that would concern me. My ds takes Advair, but I would avoid it with dd since it *can* cause growth delays. (As I understand it, children typically catch back up to where they were expected to be when the Advair is discontinued -- but it would still make me nervous with a child for whom growth as already an issue.)

 

The problem is, he doesn't have asthma, he has bronchiolitis obliterans. He has under 75% lung capacity now and they are working to keep it stable. I'm not sure his pulminologist has any plans for him to ever come off the advair. I guess we can talk to the endocrinologist about it and then back to the pulminologist.

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The problem is, he doesn't have asthma, he has bronchiolitis obliterans. He has under 75% lung capacity now and they are working to keep it stable. I'm not sure his pulminologist has any plans for him to ever come off the advair. I guess we can talk to the endocrinologist about it and then back to the pulminologist.

 

In that case, I would pursue the endocrinologist. It sounds like your ds *does* follow a CGD pattern in a family with parents who display the same pattern. *But* complicating that further with medication that may slow growth... (And I'm not suggesting you have any real choice there! Better breathing and short!) Well, I think I would want to pursue that with the endocrinologist and then, hopefully, have the two doctors battle it out as they try to figure out how best to treat his lungs and his growth.

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My oldest was very small and physically immature at age 14. A bone age test showed 9.5 years. We just waited, and at 16 he began to grow and mature. He is 24 now and 5'10". that is below his expected height, but he has other issues as well. Our pediatrician was concerned about hormones and recommended this course of action.

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This is that other thread.

 

We're going back to see our ped endo next week. My ds is bone age advanced which means that he most likely will not have a spurt later. His last blood test done in Dec came back okay (as far as I know from a brief nurse call) but they said his nutrition markers were still off - meaning he's still not eating enough. I have tried everything under the sun to get that kid to eat and eat and eat.:confused:

 

In our case the rest of us are all quite tall so they are looking at his genetic potential being way off the mark. Growth hormones might be suggested in the future, but if it's not covered by insurance we can't do it.

 

Good luck with your pulm and endo visits and keep us posted.

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Be sure your bone age test (hand x-ray) is being interpreted by a pediatric endocrinologist, not just you regular ped or even regular adult radiologist. Our son was small at 9, doc got worried, pressed us for a bone scan and bloodwork. He did not like the results and insisted we go on to the specialist. DS did routinely use pulmicort and, occasionally, albuterol and oral prednisone for asthma episodes, between the ages of 6 and 10. Of course, your meds situation is different.

 

First thing the specialist told me was that he felt the x-ray had been misread. His tone indicated that it wasn't a rare occurrence. He asked about growth patterns in DH and my family, and when I told him my older brother was a late bloomer, he was very reassuring. The blood hormone levels were normal. Come back in a year, he said.

 

At age 11, DS had a growth spurt and passed my height by his 12th birthday. At 15, he's about to overtake my 5'8.5" DH. He has not stopped growing yet.

 

Just sayin, make sure an expert is reading the test results. But the initial tests are not difficult and will help to set your mind at ease.

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My son was also very behind in height. When you are growth hormone deficient, it is NOT just about height. You are at a much higher risk for brittle bone disease. The growth hormone shots also help with that problem, if you take them until your bones are fully fused (around 17-18 years old for most).

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Yes, you certainly want the bone age scan/x-ray read by a peds endocrinologist. Ours even requested that the x-rays be done at a certain place for even more accuracy. Our local hospital and radiologist read it incorrectly by several years which can make a big difference in treatment.

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My son was also very behind in height. When you are growth hormone deficient, it is NOT just about height. You are at a much higher risk for brittle bone disease. The growth hormone shots also help with that problem, if you take them until your bones are fully fused (around 17-18 years old for most).

 

:iagree: I have a niece and nephew with growth hormone deficiency, and the bone age scan was the first stage in their diagnoses. My sister has gotten a lot of criticism over giving them growth hormone from people who assume she just wants them to be taller, but they have other health issues that have been caused by the hormone insufficiency. My niece has had inconsistent bone growth in one leg that has resulted in uneven muscular development, pain, and gait problems, and my nephew has some liver issues also caused by lack of growth hormone. They both have problems stemming from lacking space in their rib cages for full lung expansion, and have had various breathing problems and recurrent illnesses as a result. I think it's great that your doctors are looking into all of the possibilities considering your son's history of breathing problems.

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I'm sorry to hijack your thread Mrs. Mungo, I am really interested in everyone's responses to your question as I am considering going to a ped endocrinologist with ds also.

I have a question for those of you with kids with a bone age delay. My ds had a bone age x-ray done at age 8 (6 months ago) and it showed his bone age as 5. He is very tiny and not even on the chart. He is on his own line.

My question is about his teeth. He has only had two adult teeth come in. His ped. dentist took those panoramic x-rays and said that his x-ray looked like that of a 5 or 6 year old. To me this makes sense. But she said the bone age and tooth development weren't neccesary correlated.

I guess my question is, what experiences have you had with tooth development and bone growth?

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...But she said the bone age and tooth development weren't neccesary correlated...

My (limited) understanding is that they aren't *necessarily* correlated -- but often are. My dd's teeth are only a little behind average (and still within range) even though her bone age and growth are 2-3 years behind. But when I was reading, it seemed that having tooth development more closely allied to bone age was pretty common.

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...what experiences have you had with tooth development and bone growth?

 

For us, the lack of correlation between dental circumstances, placement on the growth chart and chronological age were the three triggers for the first doc's initial concerns. However, my son's situation was different in that he was chronologically 9 years, bone age (as initially interpreted by the hospital, not the peds endo) 5 years, and losing/replacing teeth like an 11 year old. The pediatrician did not like that set of circumstances.

 

Peds endo reread the bone scan at 7+ years and was satisfied with normal blood work results, dentist said kids vary so much in teething that he was unconcerned about it. As stated above, DS has grown like a weed and now looks down at me.

 

Definitely have things checked, as there can be issues that need to be addressed. You just want to be sure you get a good diagnosis!

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I had precocious puberty as a kid. (Was a C cup by kindergarten, growth spurts and off the growth charts, got my period the month I turned 8, etc.) They did regular bone age tests on me, which showed I was way ahead. The issue with precocious puberty is that while kids are off the top charts, they complete their growth and stop growing at early ages. So they often wind up significantly shorter than average. This happened to me, but my projected height had been six feet. (My sister is 6' 1".) So my height of 5'6" is fine.

 

But, my experiences with being ahead of the growth curve is that I would give hormones or whatever was needed to my children. Being significantly ahead or behind agemates is something to consider treating, for psychological reasons as well as physical.

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  • 11 months later...
We are military and he is being seen at a military facility. So, there's no insurance company to haggle with. My son has a lung disorder and regularly sees a pediatric pulminologist. The pulminologist ordered the bone age scan and is referring us over to the endocrinologist.

 

If your kiddo is on steroids for the pulmonary problem, the bags guy might be worried they are affecting his growth.

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I don't think there is anything wrong with being small so long as there aren't other health factors indicating a problem.

 

There is 15 year old girl in our 4-H group that is only 4 ft.9" and she is done growing. Her parents opted, against their doctor's advice, not to check out her growth issues through her younger years. They just felt that small was okay and it is. But, unfortunately for her, being way smaller than average was a symptom of thyroid, pituitary, and hypothalamus disregulation. Her bones are calcified so nothing can be done about her height and she has damage to her glandular system which they found out about far too late. She won't be able to have children. Her endocrinologist hopes that he'll get her to the place that she'll start her period by 18 and even then, she'll probably only have it three or four times per year and that's with a lot of intensive pharmaceutical therapy. She is expected to look aged quite young and a ripe old age is probably not an option though the medical history on both sides of the family would suggest otherwise.

 

The difference in your case is that you and your dh are not tall people. You are small and petite and that is your son's natural heritage. In the case above, both sets of grandparents are tall, both parents are tall, older sibs are tall, etc. Her mother is 5'8" and her father is 6'2". Her brother is 6'3", older sister is 5'9, and her little sister - nine years younger, will surpass her in height by 5th grade. It was an indicator of something being seriously wrong because it was such an anomoly. It doesn't sound like your son is varying from natural growth curve of his medical heritage.

 

I guess I would probably be inclined to go ahead with testing just in case, but assume that he is taking after his family trait and this is normal unless something substantative showed up.

 

Faith

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I would go through testing based on my friend's experience. Her DD was shockingly small but they didn't want to push for invasive testing and didn't want to do the growth hormone shots even if she had a deficiency and would be a small adult. The Dr warned them that lack of growth may lead to very significant heart and lung problems. Their DD already had some lung problems because of an injury so not treating her growth hormone deficiency (found after further tests) could have been very bad for her. Treating growth hormone deficiency is not just about height! Their family also had a history of constitutional growth delay that resolved on its own during puberty and her other children are also extremely petite but the one with growth hormone deficiency is different. She had several bone age scans before they went on to further testing and each year the gap between real age and bone age grew. Once they learned of the serious consequences of not treating her growth delay they started the shots and the effects have been amazing. She is a much happier more vibrant child now.

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I agree. As it is, doctors ignored our concerns for THREE years. They now say that she will be permanently smaller than she should have been and will be 3-4 years behind in losing teeth & puberty. So instead of hitting these milestones with her peers, she will be on her little sister's calendar. I wish we would have been able to treat her sooner.

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Bumping this up (sorry!). My 6 yo was ridiculously small and after several doctors told us "just feed her more" we finally got a doc to do a bone scan and bloodwork. Her bone age was 3.5 and she has profound hypothyroidism (617 tsh). Thank God we got a good doctor and now a pediatric endocrinologist!

 

I do agree that it's important to see an endocrinologist and get testing done for all of the reasons listed below by Faith. In our case we worked with a pediatric endocrinologist for over a year (this is an old post, I know you bumped it, but I'm not sure everyone else realizes it's old ;) ), did lots and lots of testing, and no problem was ever found.

 

If your kiddo is on steroids for the pulmonary problem, the bags guy might be worried they are affecting his growth.

 

Yes, the two docs worked together and eliminated most of his meds. They got him down to advair 2x/day and 1/2 a zithromax 3x/week. But, take him off the advair and his lung problems started kicking back up. I think the endo was mostly decided that it was genetic. He felt ds will eventually be taller than his dad, it is just going to happen later than usual. However, I think if we had not been moving, he would have started with growth hormones at the end of last year because ds made very little progress growth-wise.

 

I don't think there is anything wrong with being small so long as there aren't other health factors indicating a problem.

 

That's just it. My ds does have other health problems. His pulmonologist felt like there was an underlying problem that was causing his lung problems (his condition is extremely rare) *and* his slow growth. BUT, they can't find a connection or any abnormalities to explain *either* problem.

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ETA - oh, heck, I see this is an old post, still wishing a smooth move for you.

 

 

(haven't read every reply)

 

You must must must have these films interpreted by a pediatric endocrinology specialist. To worry about anything before you have that expert opinion is to waste lots of emotional energy. Don't let a regular pediatrician scare you or order a whole slew of tests before the expert speaks.

 

DS1 went through all this. Ped endocrinologist finally saw the bone age tests, took a family history and told me that the pediatrician was wrong, the scan showed him older, that mistake happens all the time, and based on our history son was likely to have a late healthy growth spurt towards the end of his teens. At 16 he is now 5'8" and still growing.

 

Hope you will soon get more definitive info.

 

BTW, hope your relo has not been too painful, I'm guessing it's still in

progress.

Edited by AuntieM
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ETA - oh, heck, I see this is an old post, still wishing a smooth move for you.

 

 

(haven't read every reply)

 

You must must must have these films interpreted by a pediatric endocrinology specialist. To worry about anything before you have that expert opinion is to waste lots of emotional energy. Don't let a regular pediatrician scare you or order a whole slew of tests before the expert speaks.

 

Ds didn't see a regular pediatrician all last year. It was all back and forth between the pulmonologist and the pediatric endocrinologist (who is older than most army docs, my friend with diabetic sons recommended him) DS had a lung collapse after a biopsy late last summer. Because of this they both sort of put off a bunch of stuff. The biopsy did not turn up anything. Neither did the genetic test for cf that they did just to be sure. His scan definitely puts him that young. He is nine years old (will be ten in April) and he's around 46 inches tall. The good news to the endo was that it meant he has a lot of growth potential, and maybe it is just delayed growth. However, he was worried when ds only grew a few cm in the year the endo was personally measuring and weighing ds every couple of months. I think he would have started ds on growth hormones if it had not been for the lung collapse and then our impending move.

 

They have tested all sorts of things in the meantime and come up with nada. I am just not sure what to think about it all at this point. My mom is worried that his lung problem is due to asbestos exposure when we lived in Germany. The pulmonoloist is stuck on a lung disease you get from birds, but ds has no real exposure. If you (or anyone) has any more experiences or ideas, I would love to hear them.

 

The move is going fairly well. We are supposed to sign for a house on Friday, we are hopeful our stuff will get here soon!

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Several years' experience by now, with two children.

 

I'll assume that you are working with a pediatric endocrinologist.

 

We have not had any testing other than bone ages and bloodwork.

 

What is your doctor recommending for tests, and what does s/he suspect might be the helpful information?

 

I just called out to my husband to ask about the math formula for boys. He says that, to predict the mean height for a boy, do this:

(1) Take the mother's height in inches, and add 6. (In your case, then, 62 + 6 = 68)

(2) Average the result of step 1 with the father's height in inches (In your case, your dh is 66 inches tall.).

(3) Your son, then, would be predicted to reach 67 inches -- the mean target height for him. (I'm using "mean" in the mathematics sense.)

 

Antonia

 

 

That didn't work with my son. I am 5'7 and his father 5'8. My son is 6'2 but all of my brothers are over 6'2 as was all of my uncles on my mother's side so I am thinking the height gene is pretty strong on my side of the family. Do you happen to know the formula for girls? My oldest is 5'11 but the next three are 5'6 and the last isn't done growing yet but I suspect she will be about 5'6 as well.

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