Would this growth chart worry you? Faltering growth pre schooler

[sillysoup]

Dd is 3 years 9 months 94cm
Grew well until just after she had turned 2. Does has Gastro problems but no diagnosis as yet.
Weight is static too at around 13/13.5kg but less of a concern as she isn't losing.
Her growth is now being monitored monthly. Have just got the print out.
What do you think. Is this cause for concern?
Has anyone had anything similar with their child?
(The downward spike at 30months was a misplot)

I don't have similar sorry. DS and DD (2yrs 8 months and 9 months) have gone the other way with their centiles and DD is now off the chart for length and 98th for weight and head. DS has always been similar. Surely some go up and down and it's a general pattern?

To me it doesn't look something to be overly concerned about but I'm not a health professional. I know DS definitely grows in big spurts and then nothing suddenly fits him but then he'll be static for ages. I don't think my DC can sustain this growth so I'm sure they'll drop down the centile chart at some point.
It's not like it's gone from the top line to bottom or like it's particularly severe, just something to keep an eye on to make sure she doesn't catch up?

Thank you for replying I see what you mean, that Makes sense, I hadn't looked at if from the other side too we may have caught her at a slow time in her growth and she may shoot up soon!
She has been in the same size clothes and shoes for a very long time. They wear out and I have to buy the same size again.
The growth slowing right down when she started on heavy duty laxatives so I am wondering if that is playing a part. even though the doctors say it won't be the cause, I'm sure it must have some kind of effect!

I would query the gastric issues and it is hard to see how they can't be related. I have small children who's growth has slowed and they have lots of food tolerance issues. It seems we have traded health for growth, right now I will take health and hope growth follows.

Another do you feel the food issues have affected your dc's growth?
Dd has the most severe chronic constipation I have ever known of in a child. She has been hospitalised for nearly 2 weeks once and can't have a BM without an extremely strong laxative.
Wondering if it could be malabsorption but don't know if that would affect height

Is her weight around the same centile as her height? I would be a bit concerned given the downward trend in growth, but it could be explained by the gastro issues. I would definitely raise it with her medical team.

For reference, my DD is a couple of months older and weighs 15kg and is around 102cm tall. She has put on around 1.5kg and 6cm in the last year. She is a fussy eater but is pretty much tracking the same centile for weight and height.

Hope this helps and you get some answers.

Who is monitoring her at the moment? If she crosses 2 centile lines NICE guidelines say she should be referred to a paediatrician. If you also have concerns about her GI tract I'd probably request referral sooner rather than later. My DD sees endocrinology for poor growth (in her case likely related to steroid treatment) and had a load of blood tests done at her first appointment, including coeliac disease, growth factor, general blood screen, vit D and calcium. They look at growth velocity as well as actual height, your DD is a 'normal' height (my DD off the chart tiny) but her curve is flattening out, unless something changes she will drop further centiles. You might find they want to monitor for 6 months and see if she has a spurt, but it wouldn't hurt to have a plan in place if she doesn't, like everything else the waiting list for paeds/endocrinology is long!

She is just under 25th for weight, was 50th when a toddler.
She was lower for a time when she was ill but has put about 1.5kg in in the last year. As her height isn't going up the difference between weight and height is getting bigger iyswim.
My worry is the straight line. She has grown 2cm since this time last year. Everyone is shooting up around her. Her face is looking more grown up and head looks like t is growing but the body is tiny and very soft and squishsy babyish really

What height are you and her dad?
This is relevant too, as well as growth velocity and centiles. 9th centile means that there are 8 children out of a hundred smaller than her.

What centile is she for height?
Is she active, energetic and generally well?

What gastro issues does she have?

All that is relevant and just looking at a chart will not allow any of us to help you further.
I think in a well, energetic 'healthy' child a watchful wait approach is reasonable for 2-3 months; if she is not well, that's a different story.

x-posted with you.

Milo, that is it, she is a normal height but won't be for long if it keeps going this way. Like you said she is falling through the centiles steadily.
She is under a Gastro specialist and has just had a biopsy to tear for hirchsprung's disease. Ceoliacs and thyroid tests are always clear.
We are hoping to get a refferal to encro once the consultant sees the print out.

I am 5'3 but was never particularly small as a child. Dad is 6'1
I have another dd different dad (5'7) and she was 102cm at this age

It sounds like she is getting the right kind of investigations done, and yes, endocrinology may be the next step.

Milo is your dd having any treatment or are they keeping an eye on her for now?

A downward trend and growth of less than 5cm a year should be investigated. If the gastro doesn't pick anything up you should see an endocrinologist. Will they check a biopsy for coeliac too? Blood tests can give false negatives.
The Child Growth Foundation might be able to advise better.

Yes ask for referral to growthclinic.
They will just track her for six months any way

It's all incredibly slow with growth problems - DD is 7.5 and we've been seeing the endocrinologist since she was 2.5 and still don't have complete answers.

What tests have they done so far?

My DD fell from 97th centile (her genetic predicted centile as DH and I are both tall) to 4th centile by the time she was 2. She's now on 9th centile and has been for 18 months. Way below where she should be, but the consultant is pretty happy.

Her latest bone age x-ray showed a 2 year delay and her IGF-1 levels are just detectable (for the first time ever).

Despite no complete answer and being well off her genetic centile, we're moving to appointments every 18 months with a repeat of blood-tests and x-rays each time, and not attempting to treat or diagnose unless she stops growing again.

We had the usual gastro battery done, loads of assays for growth hormone markers plus karyotyping for Turners and a stim test for growth hormone done in the first 2 years, but it's all very slow as they only like to measure at 3 month intervals (private and NHS were the same on that).

I would push for more investigations on the gastro side rather than the endo.

The Magic Foundation in the US is quite helpful, and there are some good FB groups for different conditions.