Son small for his age and struggling

[LoopyLucyLou10]

Hello, just posting here for traffic.

I'm just after some advice about my son as I'm running out of ideas.

My sonis 6 and was born small (5lb 3oz at full term) due to the umbilical cord being too thin which went undetected during pregnancy however his growth was monitored. He has always been below the bottom centile for his height and between the ages of 2 and 3 he underwent many tests to rule out anything that could be causing his growth problems. The outcome was that he is very healthy, produces an above average amount of testosterone and growth hormone and there is nothing to indicate why he isn't growing as he should be.

He is not expected to reach 5ft and will probbaly be somewhere between 4ft and 5ft by the time he is 18. The advice I have been given by various doctors has been that nothing can be done and he will just have to learn to cope as he gets older. Which he has done brilliantly and despite his size he has reached all milestones either early or on time and is an intelligent boy. The problem we are facing at the moment is that although he is 6 he is essentially stuck in the body of a 3 year old and therefore he gets very tired. He is struggling to keep up at school because by the afternoon he is exhausted which is effecting his performance at school however because he has no additional learning needs he is not entitled to any extra help such as extra time with a teaching assistant etc.

I am currently thinking about taking him out of school and educating him at home, with one to one time we would cover a full school day by lunchtime and we would be able to miss out the period in which he begins to struggle. He is also facing difficulties fitting in with the other children due to his size, he is in year 2 and the youngest in his class (August baby) and it's severely effecting his self esteem.

I hate to see him struggling and being so unhappy. Does anyone have any advice for me either from experience or outside perspective?

Thank you in advice.

I don’t understand how he can be producing above average growth hormone yet not be growing.

She didn't say he wasn't growing, but that he was under the bottom of the chart.

A boy who is tracking the bottom of the chart at 3 years old who is again tracking the bottom of the chart at 6 years old has grown about 18-20 cm which is a good rate and well within the expected range.

A child who was average at 3 years old and average at 6 years old has also only grown by that much. I honestly don't know how to make it clearer?

But I've explained how there is a massive overlap in heights of a room of 3 year olds and a room of 6 year olds
Definitely my DS is the opposite end he is huge, there are boys close to his height and some up to his elbow, especially the Asian boy's in his class some would easily pass for 2.5 y.o's.
OP he may take a stretch, if not there has to be a reason.

I don’t understand how he can be producing above average growth hormone yet not be growing
Surely you've noticed the different stages on a centile chart. DD was 35 DS was 99. My babies were a little chip compared to a big potato.

Do you think think that’s within normal range?

If he's had hormone deficiencies and other things ruled out and that's a prediction based on how he has steadily tracked the graph, then yes, it would be normal for him.

The most common causes of short stature in childhood are constitutional growth delay or familial short stature. In constitutional growth delay the child tracks low on the graph but then grows more than average during puberty. This is twice as common in boys as it is in girls.

My son was born a normal length and weight, but was small for his age all the way through childhood - he followed the 2nd centile line, pretty much, for height. My family are all tall (men are over 6ft, and I'm the shortest female at 5'8"), but dh's family are all quite short - dh is 5'5". Ds didn't really start puberty until 15+, which was tough for him. He was also an August baby but we didn't consider delaying him starting school (not that you were allowed to in those days - late 90s), as he was socially mature and academically able and "ready."

And now he's 23, and has exceeded all expectations height-wise and is 5'10" staggeringly good-looking and doesn't look out-of-place at all with all those boys who towered above him at school.

The only thing we could do in the early years (and I confess I was really worried about him), was to ensure that he was confident in himself and had comebacks up his sleeve to bat away any unpleasantness or bullying from others. Fortunately, he is a strong personality and outgoing (drama/music) so he managed this well. We trained him not to react if teased, and to treat anything coming his way with humour and not to let anyone see if he was upset about it.
It worked - he never had issues in that way.

Good luck with it all.

Callmeangelina that sounds exactly like constitutional delay. We all worry about our children, but it's depressing when other parents are suggesting you've been 'fobbed off' when professionals have ruled out the bad stuff and the data suggests its nothing to fret about. But what would drs know eh?

Has he been tested for coeliac disease op? My ds reached age 15 and only measured 4ft 9 and tests showed he was coeliac- he was always really active and seemed well but just didn't grow! He's been following a strict gf diet for the last 18 months and is now 5ft 3 with an estimated final height of 5ft 8.

The way it was explained was his gut was so damaged from the gluten that he was only absorbing enough nutrients to keep him alive and serve his energy needs but nothing left over to grow with.

Might be worth looking at but apologies if you've already gone down that route.

Headinhands this kid's predicted adult height is less than 5ft - that's well outside the normal range, even though there is of course an overlap in expected height and age.

OP I'm not an endocrinologist or anything, but just because he is producing the right amount of growth hormone doesn't necessarily mean his body is metabolising it correctly. You really need to push for another opinion, from a centre of excellence not just your local hospital that your GP commissions to.

Just for everyone talking about growth hormones...my daughter has Shox syndrome (basically the name given to most growth hormone deficiency syndromes) she has short legs and a regular size body and has been on growth hormones for a year. The difference it has made is incredible, she has grown more than 6 inches in a year. It isnt fun for her having to have injections every day and it is awful having to give injections every day but seeing her growth is worth it!

Headinhands this kid's predicted adult height is less than 5ft

That's going on where he is now, but with constitutional growth delay the child grows more than other children during puberty and crosses the percentiles such as the previous poster detailed.

I'd ask to be referred back to endocrinology. My daughter was the same birthweight and stopped growing after steroid treatment as a baby, meaning she fell off the bottom of the charts. She had the endocrine testing age 2 but has since improved without treatment and is now 2nd centile with good growth velocity. I don't recognise the "small therefore exhausted" story at all - that sounds like there is also an issue with energy levels/metabolism and since it is enough to be adversely affecting his education I would not accept that without having it reinvestigated. My nephew is very short and has also had the testing, so it's possible there is something genetic in our family - my sister is really worried about the future impact on him if he doesn't catch up at some point, I think it likely to be harder for a boy to have very short stature. The Magic Foundation are very helpful if you haven't already found them.

Thank you again for all the replies.

The GP was very understanding and did have some suggestions such as repeating the school year, having a snack in the afternoon, she gave me some details of emotional support and therapy that he could have at school, encouraging him to have a nap when he comes home from school and asking the school whether he could maybe have a half day on a Friday for example so I can do some one to one work with him at home to help him catch up. Most of what we have been focussing on is building his self esteem which is quite low, he feels he is not as good as the other children which breaks my heart. He's a brilliant little boy but he is really struggling this year with how he looks etc and if it is relevant he also suffers with chronic eczema which can cause great big red rashes on his face, arms and legs. His eczema is well controlled however a sudden change in the weather causes him to have a severe flare up and it can take about a week to get it under control again.

As for the medical side of things, there really isn't anything to suggest that it's anything sinister and he has already been tested for everything, he spent a very long time being in and out of hospital having many many tests and everything came back clear. His vitamin levels are good so no vitamin deficiency and his energy levels in general are good, it's just school he is struggling with. She did suggest that the tiredness in school is just him expressing that he's unhappy, struggling with the work and suffering from low self esteem because he's behind the other students, which is true.

She also suggested having a meeting with the school to discuss other options about ways to support him. His school set reading homework every night and some maths or English each week which he is struggling to do because he's discouraged from feeling like he's not doing well enough.

Just wanted to say thank you for all your ideas and support!

That's going on where he is now, but with constitutional growth delay the child grows more than other children during puberty

Not necessarily - one of mine had that and despite being reassured that his bone age was a lot younger and he'd be growing for far longer than his peers, puberty hit him early and he stopped growing just as his peers were shooting up.

If an endo has predicted that as an adult height, given his blood results etc, it's likely that the endo knows more than either of us.

If an endo has predicted that as an adult height, given his blood results etc, it's likely that the endo knows more than either of us.

Did the endo predict this? As I said earlier there are always outliers, doesn't mean it's something that needs medically sorting.And tests show it isn't

but just because he is producing the right amount of growth hormone doesn't necessarily mean his body is metabolising it correctly.

Did op say he wasn't growing?

it's likely that the endo knows more than either of us.

But you're the one suggesting you know more/better than the professionals, not me.

My ds was always tiny. He was always 2 years below his age in clothes. Since puberty now towers over me and is as tall as his dad now. Quite a few parents said they really Jones puberty would come and he would shoot up and he did.

All the tests the HV insisted on came back with nothing. He just took longer to grow. The paediatrician did comment he was a bit like a plant going by the regular growth charts we needed to do.

My son is on the short side. The pediatrician said that apart from growth hormones, using medication to delay puberty could have made my son taller but by this stage he was "too old". Is delaying puberty something that you could ask about?

Has he had any testing for coeliac or allergies? The combination of tiredness, slow growth and eczema suggests this is a route that should be thoroughly checked out.
Also have his heart and lungs been checked out?

I know he’s had lots of tests and maybe these were included but it sounds more like they focused on endocrine and so might not have pursued other angles?

I have small dc - clearly genetic in our case, as dh and I are both short, MIL is very short, my father is short and other family members are of average height at most. My eldest is on the short side and also skinny. The younger two (one boy and one girl) in particular are strikingly short, perhaps not quite as much so as your ds, and while ds2 was 3kg at term+, dd was 2.5kg at term+. He is now 12 and she is 4 (same height as ds2 at her age but almost 2kg lighter - she has ds2's height plus ds1's build) and I also really don't recognise the afternoon exhaustion; although dd can't climb the big equipment at the playground like her taller, less slight peers, she's as fit as a fiddle and manages on scarily small amounts of sleep. Ds2 (also one of the youngest in his year) is robust and muscular and keeps up very well in PE etc as well as lessons.

We have never gone down the growth hormone route because we were and are reluctant to interfere with healthy children's bodies and potentially psychological states in order to make them more socially acceptable (iyswim). It's also very evident where our children's statures have come from. The exhaustion (and you not mentioning this height/size being a familial thing, unless I missed a post about that) does make me wonder whether something is being missed in your son's case, though.

Unless there's something else wrong, the weight at birth doesn't determine height at adulthood, my nephew was 5lbs at term, is over 6ft now. He was small until puberty though