0.4 Centile for Height

[pixiekid]

My ds just had his 12 month review and is measuring 0.4 centile for height (-4 corrected), which based on his actual age is just below 0.4. He's consistently charted on the 0.4, so is following the curve but my gut instinct is to be very worried, esp now that he'll be measured based on his actual age going forward. The HV seemed unconcerned but I'm wondering if it could be a sign of an underlying problem. Should I be pushing for a paediatric referral?

He was slow to regain birthweight (took 4 weeks) but quickly settled on the 9th centile for weight. Any thoughts/experiences would be welcome!

[bizzey]

Hi pixiekid...I am going to reply ,but not sure I will be of much help only to let you know it is not unusual !

My ds3 was born on the 50th centile (8lb) lost all his baby weight and never gained and stayed on the lowest one for weight (?2nd) and 9th for height..

But because his "curves "are in order they dont bother too much .

At 12 months I bet there is alot of "wait and see"...and I have had alot of dr's' say well that is just the way he is going to be (short)long and skinney...he is 8 yrs now and still low on his percentiles BUT not the smallest in his class !!

I personally would mention your concerns and request a referal to a pead (try and avoid doing dietian...they just say say give them lots of fatty food ! unless your ds has food issues )

Sometimes there are no underliying issues ...it is just the way our childeren are ...but I agree ...let them know you are concerned and you do feed your child !!!

BTW .blood test were nearly all normal for ds(wrong ones were nothing to do with digestion) but I was amazed at how many things he was beeing tested for !

HTH

[Goldmandra]

So your DS is within the normal range for his age, albeit close to the limit.

When you say you're gut instinct is to be very worried, would you feel the same if it were not for the growth chart? What I mean is do you feel that he is otherwise healthy and developing as he should?

Some children have to be at the outer limits of normal. Looking at the height of his family where would you expect your DS to be on the chart? Are there other children in his generation who are also low down on the charts?

Try to look at this information in the wider context of his genetic predisposition and his general health and development.

If you do that and still think it is reasonable to be worried it would be perfectly reasonable to ask for him to be referred to a paediatrician for reassurance.

[Bonsoir]

Yes, you should definitely be pushing for a paediatric referral.

I have two children close to me (one a family member and the other the child of a close friend) who "dropped off" the growth charts at the end of their first year of life. They are both now 8 years old.

One recovered fully (and is now on the 75th centile and a high performer in school), the other is still tiny and is underdeveloped in every way (still cannot read).

[mejon]

His weight and height are pretty much equal - I think if there is a difference of more than 2 centile points between either then that may suggest that a child is under/overweight etc.

This time last year DD1 who's just turned 6 was just off the chart for height. She was measured as part of a project in school last week and is now on the 2nd centile! There's no chance that either of our DCs are going to be tall as both DH and I are short as are all our immediate families. DD1 is still the shortest in school but is perfectly well developed in all other aspects. Certainly mention your concerns to your GP but in reality I'm sure there's nothing to worry about.

[headinhands]

Some children have to be on that part of the chart. Doesn't mean there is anything wrong in the same way a child at the top or middle is wrong. Is the previous poster actually linking height to reading ability? Ds is on bottom of chart but no problems reading at all. If all kids should be near the middle then why is there a several foot difference in the height of adults??

[bizzey]

headinhands...I think you have made a really good point there ...all childrene have to be somewhere on the chart.

I have (wrong I know !) always compared my ds's on their percentiles ...but when you compare it properly ..we are talking in cm's differences(or at a smaller number inches ! )

I know ds3 is growing as I still have to buy new clothes ..he is 1 year behind agewise on school trousers on low percentile but so is ds2 who is 75th percentile for height ???

Starting to think these charts ..percentiles in red books and averages in clothes sizes do not help us..and just add for something else to worry/concern ourselves about.

All I now know is my boys eat all day long (if they could..and if I had enough in the house!)..and that they are growing as they genes tell them to ..and that they are healthy!

(As an aside..."little"ds3 does have a bit of global delay thing and is about 2-3 years behind ...I have now totally contraticted my post I think and await to get slated !!)

[JustGettingByMum]

Can I try and offer some reassurance?

My eldest was born at full term, and was on the 3rd centile for height, and pretty much stayed there for the first few years. By the end of primary school he was pretty much average height, and by 16 he was over 6 foot tall.


He was always in the top groups for school work, and is now doing very well at Uni. He's still very skinny, but then so was his dad at 19!!

[bizzey]

justgettingbymum...Thank you from me !! My ds has long and skinney fingers/toes/arms/feet/legs (high hips)....just dont think his torso has caught up yet !!! Good to know it doesn't always stay what the percentiles state !!

[headinhands]

And even if even if small boys turn into small men that's fine too Dh is shorter than me.

[MoelFammau]

DD was born on the 50th centile but had dropped to the 0.4 centile by her 12 month check-up. Her weight though has stayed consistently on the 50th centile. She's now 17mo and a pocket-rocket. She out-performs her (strapping 98th centile) 22mo male cousin both physically and verbally and is exceptionally strong.

We were initially surprised about her lack of height as I'm 5'8 and DH is 6'1, but it's certainly not holding her back any.

Shorties aren't always frail, just thought I'd say that!

[Sleepwhenidie]

The difference is that 0.4th centile is not considered within the normal range. And what is expected from your child depends on yours and ds's dad's height. Ds2 was not evfen on the charts from 20wk scan and was born on 0.4th centile (height and weight). He has been carefully monitored since then and has remained on more or less the same point on the chart. He is perfectly healthy and developmentally fine but will probably need growth hormone therapy.

I would get a referral, get him checked out and start monitoring him over the next couple of years. It is unlikely they will do anything else provided they rule out any other health issues or dietary problems. We take ds2 every 6 months to endocrinology consultanht.

[Bonsoir]

Being at the extremities of the growth charts (in height or weight) is a red flag, just as being at the extremities of the IQ charts is a red flag.

[Goldmandra]

My HV told me that the centiles are calculated for healthy children therefore being on the extremities is OK especially if the child is following family traits. The worry would be if the child is very different from the expected growth pattern for their genetic make-up or there are other concerns about health or development.

Maybe she was wrong

[ReallyTired]

Bonsoir

1 in 4000 healthy children are on the 0.4th centile for height. Both dd and her cousin are on 0.4th centile for height. DD's cousin is nicely on track for a level 3 in reading in her key stage 1 SATs. Dd's cousin has also recently got her badge 1 in Gymnastics. Dd is still functionally illiterate at the age of three although she does know her letter sounds. Like her cousin she is healthy and confident.

Our health visitor came out and weighed and measured dd. She told me the important thing was that dd was growing. Ds was on 0.4th centile for height, but grew later.

Goldmandra your health visitor is wise. You need to look at the child and their overal development. DD has had extra development reviews which she has done really well at.

[pixiekid]

Thanks for all of your thoughts. We ared ue to back in 6 months to get measured again so depending on the outcome will push for a referral. My main concern is that whilst im petite im not really small and dp is over 6ft & charting below 0.4 is worrying me. I guess my main worry is that he has a growth hormone deficiency.

[Goldmandra]

I'm glad you're not being dragged back to measure him too often. That just causes anxiety without finding out anything significant.

If he does have a problem like growth hormone deficiency at least it will be recognised early. If not you will be able to relax.

If you feel there is a reason to ask for a referral don't be fobbed off. Be firm and insist that you feel that there is a need for him to be seen by a paediatrician so could the HV please make the referral immediately.

[sanserif]

My DS was born in the 7th centile for height and weight, stayed more or less at that, dipping a bit here and there, and then dipped to the 2nd centile around his 3rd birthday at which point I asked for a referral. I'm 5'3" and DH is 6'1", so he's below what it seemed he should be. The paediatrician just looked at him a couple of weeks ago (he's now 3 1/2). When she measured him, he was back up around the 10th centile.

She did a series of behavioural tests on him as well as the usual health check type stuff, also checked his testicles had descended, that his bum was firm (apparently this is the first place to lose fat if you're malnourished) and for 'midline abnormalities' (these are frequently linked to growth problems). She seemed to think that it was quite likely he was just wrongly measured at the reported 2nd centile dip. Especially when they're babies, it is very hard to measure them and I'm not convinced that even the professionals are able to do it that accurately. According to her, he's fine and will likely just be short. I was worrying about this for ages, so it was nice to be reassured. This site lists common problems associated with grown hormone deficiency: bestpractice.bmj.com/best-practice/monograph/839/diagnosis.html.

[InMySpareTime]

My DS has always been on the 0.4th centile for height, variable between 2nd and off the chart, shh don't tell for weight. He eats like a horse, more than me, sometimes more than DH. He's 11 now, and 4'3". The main thing is, is your DC growing over time, active, and eating a healthy full diet. If they are doing all that, you can't stretch them or force feed them, they'll grow when they're ready.

[Sleepwhenidie]

inmysparetime they won't necessarily grow when they are ready if they are lacking growth hormone though!

Ultimately it is your decision as parents (and DC's if older) about whether to go down the route of growth hormone therapy, but if doctors look at a child and say that it is an option then you can consider it. If our ds2 remains on the same growth curve he will be approx 5ft 2" fully grown. I am 5ft 5" and dh is 5ft 9" so you would expect him to be taller than that. Some people would have no problem with 5ft 2" man but others may prefer to give their child the chance to be 4-5" (or more) taller with GH.

[sanserif]

Is there a normal age at which GHT is done?

[headinhands]

Most children of short statute aren't lacking in growth hormone though. Would you give growth hormone if they were just short.

[Sleepwhenidie]

Consultant endocrinologist advised us that 3-4yo is a good time for best results and also good that dc will have reached an age where they understand that they are significantly smaller than their peers and want to change that and therefore have some understanding of the need for the injections. It can be done earlier or later though.

As I understand headinhands, growth hormone therapy would not make a child grow beyond their natural, genetically programmed height so if a child has small parents and would naturally be small themself, growth hormone would not be prescribed.

I would also say that there is also a big difference between being, say, 5th centile and above and 0.5th and below. The difference also becomes more noticeable the older children get. You can now see a big difference between Ds2 and children at his nursery who are 6 months younger yet bigger. He is almost 3 and still wearing some 12-18m clothes, he weighs approx 11kg, the weight of many 12-18 month old babies. It is easy to see his school life in a couple of years being made difficult, with other children picking him up and treating him like a baby, not being able to play sport like others his age (eg touch bottom of the pool at swimming, ride a proper bike). His brother (7) is on the small side, dd(4) very average, both as expected given my and dh's size.

[sanserif]

Reading this thread has got me paranoid that there is something wrong despite what the doctor said. Is the blood test to check for hormone deficiencies fairly straightforward to get, if I want to go private for it, anyone know? Sorry, don't mean to hijack.

[ningyo]

I would speak to your GP about this and express your concern. I imagine he's probably fine but it doesn't hurt to get him checked out and to talk about your concerns (well, the blood tests do hurt a bit but ykwim). My DS, who is 2, is around the 2nd centile (was just below 0.4th for quite a while last year); he was born on the 25th centile but has bobbed around the 2nd from 8 weeks. I asked for a referral at 8 months just to be sure all was well as I got a bit stick of worrying about it. The GP wasn't worried but agreed to refer us. We had every blood test the paediatrician could think of and in the end she said she was 99.9% sure his small size was down to genetics (she did smile when she met us as I am 5 foot 3 and DH is 5 foot 6 so, as she said when we met her, he is probably unlikely to reach 6 foot). She did say that with a growth hormone deficiency you'd be more likely to see a real flattening of the centile line curve over a period of time, rather than consistent growth along a low centile; she said it was fine for him to be on the 0.4th centile if he's growing consistently and that if there was a hormone deficiency then you'd expect to see his growth slow to the point where the curve on the centile chart levelled out to a flatter line which would then fell off the centile chart as time passes. As a result she said she felt he was fine at present and that we should visit the HV every 3 months or so for the next few years to track his growth just to be sure it was continuing to be consistent. If it dips then we will be seeing her again as well as a paed endocrinologist, but otherwise we are just monitoring and expecting that he'll always be on the short side (like us...!). HTH.

[Sleepwhenidie]

Hi sanserif - as far as i understand, the blood tests won't show up a hormone deficiency. They can do genetic tests to rule out many syndromes that may be causing small stature and then general baseline tests for comparison to normal...eg iron and vitamin levels (ds2's vit D was low, iron borderline). These can then be monitored over time.

Other than that they will measure you and DH as well as DS, work out where they would expect DS to be on chart based on you two. If he is on 10th centile I am pretty confident they wouldn't be anywhere near thinking about GH, so please don't worry, but do ask GP for a referral, privately if necessary, if you are concerned. I agree about measuring babies being a bit hit and miss, sure the paed's view of that is correct with the 2nd centile thing.