DS Too small? (or ordeal by hv?)

[Blu]

DP took DS to the HV today for his 2 year check (he is 28 months). All fine except she said he is very small, and wants to monitor him in special appointments once a month for 6 months. He is on the 9th centile for weight, 2nd for height. I am caucasian, 5'7" and of fairly staunchly-boned athletic buld. DP is Asian, 5'8"o f airly light 'wiry' build. I mention that because I have heard people say asian babies are smaller...DS has been on the lower centiles since birth. He eats a healthy diet but is VERY active and will not sit still. Should I worry? In any case, if he is healthy but still remains small, what could be done, so what could the monitoring be for? He does have some missing bones (fibula and part of foot), and I worry that somehow h has some general bone growth problem - though his orthopeadic consultant has previously assured us not.

Oh poor you. I would try not to worry, it doesn't really sound that unusual. I would guess the monitoring would be just in case he needed growth hormone or something in the future, maybe, but it seems awfully young for them to be thinking like that. My ds veered wildly between centiles at that age, I think he just grew in spurts so the chart was always a bit random. Basically, she sounds rather OTT to me. I hope it's all alright, but I would trust the orthopaedic specialist more. HTH.

Blu I can understand your concern. I have a 4 yr old who was very prem, so never actually hit the chart at all!! Luckily my GP is cool about it and hasn't referred her for more tests. However I would think your HV is just keeping a slightly closer eye on him to ensure anything untoward is picked up quickly. I really wouldn't worry yourself, what I tend to find is that HV's like to keep closer eyes on some children who are out of the norm.

Blu - I would try not to worry - my dd was also monitored for 6mths as the hv thought she was too small. She is 18mths old, very active and only weighs 20lb. She also eats a good diet - admittedly not huge amounts though. As long as your ds acts as usual I really wouldn't worry about him being "too small". Sorry can't help with the bone growth, but if you have seen a specialist about it and he has said he is fine, I would ignore what the hv says, if in doubt book another apopointment to see the orthopeadic consultant, even if it just for peace of mind.

Blu my ds2 is on growth hormone. He was always small for his age (but he has SN)he has been under the centiles from about 3 months old but it did follow a steady pattern.
He is 6 now and been on gh for just over 12 months.It is just a precautionary measure that your HV is doing.

Blu, I am Chinese (5'1", small build) and DH is European (5'9", medium build). DS is now 2, on the 9th percentile for weight and 25th for height, where he has been since a few months since he was born. DS does not eat particularly well (terribly picky), but is also very active and lively. However, my HV has never been worried about how small he is, I am probably more worried, particularly as I note all his friends are shooting past him in height. I think as long as your DS is growing, then there is not necessarily a problem - the problem would be if he weren't growing at all. Maybe the problem is that your HV sees you and not your DH, so thinks your DS should be bigger???

DS is 7th %tile for weight, 25th for height. 4yo he is only just outgrowing the size 2-3yo trousers. I am broadshouldered whitey at 5'8", DH is 5'11", my dad was 6'4", DH's brother & dad were both at or over the 6' mark. But being the class runt is par for the course in DH's family... then they grow up to be taller than average. Just the family thing.

I know it's worrying, Blu, but just in case there's a problem with your DS's growth hormones, just as well they monitor for a bit.

Blu, as you said Asian I wasn't sure where you meant but here are some Growth Charts, hopefully covering where your DH comes from.

Indian
SE Asian/Thai/Vietnamese
Chinese

HTH

That's really interesting. I never thought of that when the HV was bugging me about dd2, who has two half-Asian parents. I have to say I've stopped worrying. Blu, he's a gorgeous lovely boy and doesn't look that small to me, honestly.

Thank you, thank you, thank you everyone! The other growth charts are very interesting. (DP is mainly Indian, but of a very diasporic Mauritian family). There is no doubt that he is actually growing - quite a lot at the moment, but I have noticed that all his friends are almost a head taller, and he's a lot lighter to pick up. The HV told DP that he would probably go through life as a very short person. However, my 6'2" brother was tiny until he hit puberty. I also forgot to check with DP that they measured him standing up straight on his 'long' leg: he often stands on his short leg with the other bent, which deducts at least 2".

MI is right - he doesn't really look untypical.

Doormat: Is your DSs need for growth hormones connected to his other SNs? Do they have any side effects?

Blu, you know I have a bit of a worry with my ds who is small, despite having tal, big parents (me 5'8" and dh 6'4" and caucasian) - he's noticeable smaller than his peers at 26 months (born Sept 17) - and quite a bit shorter than your ds (so I am now even more freaked).
Your ds looks totally fine to me (lovely in fact) and I have to say, I was stunned to discover he has missing bones. He literally runs rings round my poor ds and I genuinely didn't notice anything different about his gait - but maybe that was because he was moving and climbing so fast he was a blur!

Thanks, Aloha: I must admit that having noticed how many of DSs friends are taller, I was interested to note that your most gorgeous DS is a little shorter, and also looks completely typical!
DS does have a deceptively big round chubby face (they monitored his head for a year, as the cicumference was on the top %ile while weight and height were at the bottom) and looks considerably skinnier au naturel...but for people building up a picture of him based on his %iles, he must sound like a complete cartoon character - which just goes to show how they don't quite tell the whole story!

All this will be very calming for DP: he came back in a panic: a reaction to having been bullied in a very rough school as the titchy kid....

Both mine have been on the smaller side but ds at about 4 started to catch up his peers and is now pretty average in his class. dd is small for her age (2.3 and about 86cm high) but both dh and I were small as younger kids and didn't really start to catch up until about 9/10. Although ours are never likely to be tall I'm not worried because of the inherited pattern.

I'd imagine in your case, Blu, the HV is just cautious because of your ds' other problems but the orthopaedic consultant would be the best person to ask.

I have to admit part of my worry that DS will be short is that I think life is easier if you are taller, esp if you are a man.

I think it's very hard to predict eventual height etc. My bro was by far the shortest at his senior school. On class photos there's an undulating line of boys and then a huge drop down to my bro. He's now 6'5. My sis grew until she was 21 and is 5'10, other bro is 6'4. I, meanwhile, was the fatty of the family, 9.8lb at birth and like a suet pudding in baby/toddler photos but stopped growing at 5'6 and 7.5st.

It sounds like your HV is being very wise, Blu, monitoring your ds and then if there is a problem, it can be investigated, knowing you have a base line to work from. Best wishes.

Blu yes it is connected to his medical problems.
The only side effects we have seen is that he has come on alot more than before he was on them
I must admit I was woried about GH but IMO the benefits outweigh the risks in our case.

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Thanks everyone, this really has been helpful to me.
You're right DL, it keyed right into my anxieties about his leg. I was similiarly frantic when he didn't get teeth til 10 months and thought that was a bone growth problem, too.
Doormat, v pleased that your DS has benefitted and is doing well.
When DS is older he will have bone-lengthening treatment on his short leg (because the discrepancy causes spinal and other serious problems), but they may also need to remove the growth plates from his 'good' leg to stop that getting relatively longer...so I suppose that heightens my fears about his overall height, too.

(Dadslib: thanks.

my ds1 is 28 months and 85 cm, he was 80 cm in August (measurements at home using a wall, book and tape measure !). He has always been below the 9% line, and has had a noticeable growth spurt in the last couple of months - finally growing out of shoes ! We haven't weighed him for a long time but I guess if we had done it a few months ago he would have been below the bottom of the chart.

Just to add a comment about teeth - none of my 3 ds started with teeth until 9-10 months. DS1 at 18 months had all except the back ones, and ds2 & 3 at 10.5 months have 2 and 4 respectively - and busy making more !

Dadslib - I'm really glad you posted that

Blu - my ds is a clumsy little shortie with no teeth until after one! Now I'm reading about how he should have had a daily exercise routine from day one and feel more guilty! But he is gorgeous though...

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My ds, just 3, has also been referred as he is very small for his age - always been on the 0.4 centile.

The consultant told us that as he has stuck rigidly to his centile line it was unlikely he had any growth hormone deficiency (children with GH deficiency tend to start dropping height centiles around 6 months of age when GH starts kicking in - prior to that growth comes from pre-natal hormones still in their system). A blood test confirmed this he was not deficient.

The consultant also said the most likely explanation was that his bone age was delayed. This is not considered a growth 'problem' as such, just a particular growth pattern. An x-ray of his wrist showed his bone age was delayed by over a year - in other words his bones are at the stage of development you would expect in a child of almost 2, rather than a just 3 year old. So he is now measured against his bone age rather than his birth age - and as a result is now just below the 50th centile!

Children with delayed bone age typically go through childhood being much shorter than their peers (the bone age delay tends to increase until their teens - so at 12 he could possibly be the height of a 9 year old). They also tend to hit puberty later than their peers. However the good news is that once they have hit puberty they experience the growth spurts that would be expected, and continue growing often several years after their peers have stopped - even into early twenties. So they eventually reach 'normal' height.

This growth pattern tends to run in families - although not in our case (several of you have said they or their siblings were short children but had huge growth spurts in their teens and grew to over 6 feet!).

So basically the message is not to worry, look at the pattern in your own family, and if in doubt get referred for a very quick and easy x-ray.

Obviously I wish ds didn't have this growth pattern - it won't be much fun for him being so much shorter than his peers, particulalry during the teenage years and I worry about him being bullied etc. but kids can get bullied about almost anything- we just have to make sure he has the confidence and personality to cope with being short.

Hope this helps!

Titchy, that's very interesting, and does seem to fit exactly my brothers pattern. What kind of consultant did you see? Is it the orthopeadic consultant?

(DS is now skin and bone due to 'flu for 6 days, MORE feeding up to catch up on!)

He saw a general paediatric consultant Blu - after having seen several SHOs - the consultatn really seemed to know what he was talking about.