Low weight (and height) almost 10 year old

[worryworts]

I'm not sure what else I can do. My soon to be 10 year old ds is very very slight (approx 23kg) and quite small (approx 128cm). He has a very small appetite. We have taken him to see a paediatrician who told us what to get him to eat etc and he is seeing an endocrinologist to see if he needs growth hormone. He has had an x-ray done of his hand which shows he is growing normally. However, I am very concerned, especially as his weight seems to have dropped a centile. I did mention this to endo who said "we will check him again in 6 months. He is in the 2nd centile now. His bloods are all normal but he does get ill a lot and has various allergies and asthma. Is there anything else I can do? I feel like I am banging my head against a brick wall as he will not eat any more and already struggles to eat (pretty small) portion sizes saying he feels "full".

One bone age X-ray on its own can't tell you much apart from where he is right now. I would insist on another in 6 months or 12 months max for comparison and keep track of it. Was he small at birth? The child growth foundation runs a number of Facebook groups which might help you to talk to other parents with kids with similar problems. There are a number of conditions which can cause short stature and slow growth. My son has a growth disorder (Russell Silver Syndrome) and is likely to need growth hormone soon. He's 2 1/2 but not even the size of a 1 year old and very underweight.

Have they done any chromosome screening? Some growth disorders can be detected through chromosome testing.

They haven't done anything yet except the x-ray. I find they try too poo poo everything I say. I don't think it is unreasonable for me to be worried. They are very reluctant to even test for whether he is producing growth hormone. I just feel that an almost 10 year old child under the 5th centile in weight should sound alarm bells. I cannot get him to eat more, he says he just doesn't have much of an appetite. I will ask about chromosome testing. Thank you.

Don't forget that 5% of all 9 year olds will be on the 5th percentile or less, that's how percentiles work.

Are you and your husband tall? If he's in such a low percentile (for height) and you are relatively tall I'd be concerned that he's not tracking to his genetic potential.

I'd definitely also insist on testing for growth hormone deficiency as that's not been done already.

It may be that this is just his build but as you have concerns about appetite and health in conjunction with growth I'd be exploring more. It's hard to stand up to Drs but you need to advocate for your son and insist on further testing.

Incidentally there is medication which can be given to stimulate appetite (periactin) and it might be worth asking about that and also whether you can see a dietician.

Assuming he's been screened for obvious causes e.g. Coeliac disease? Also agree with a referral to paediatric dietitian.

Endo will always wait six months. They need to tske acvurate measurements then need to see how much his growth rate is over six months. Hence the need to be patient.

If his height and weight on similar centiles 2nd and 5th not far apart then maybe he just small..but the six month growth rate will give more info. Until you know that info you can't go further.
Did they take bloods for coeliac etc?
My dd showed only 10 mm growth in 6 months well below the norm... She was diagnosed coeliac.

So wait for the six month appt with endo
If growth rate is below average e.g. only 1 cm he will get more testing.growth hormone stimulation etc
If growth rate is average I think it s 3 cm over 6 months ? you can ask about other options.

Same size and weight as my dts -they have just turned 10. We did all the tests. They are healthy but predicted they will be normal height but not reach puberty until about 17.... late development is genetic. Nothing we can do abut it.

We saw the Paediatrican the other day after 6 months. According to her the bone x-ray came back normal. He is now 10 years old and he has grown about 3 cms in the past 6 months, so on the 9th centile for height and 2nd centile for weight (he weighs 24kgs). They took his bloods so will be checking for coeliac, IGF-1, TFTs, renal, iron and liver function. His legs are like sticks. He does eat but has a very poor appetite and I doubt he is eating even 1000 calories per day. Wondering if he could be coeliac as he has very poor enamel on his teeth and lots of problems which apparently is one symptom of the disease, plus a sporadic rash on his knees and elbows.

I could have actually written this about my dd! She is 10.5, 23kg and around the same height as your ds. She suffers health wise a lot and she is being tested for lupus atm (for other reasons) but the docs never seem concerned about her size despite her dad being 6'2, myself 5'9 and her sisters both tall for their ages.
She has another check up in a couple of weeks so I will mention her size again, we weren't even offered an X-ray or anything, just told she is petite and will catch up at some point 🙄
Does your son worry about his size? My dd is very sensitive about it, hates the way she looks (and hates that she can't go on any rides yet!) She is the smallest in her class and a few children have mentioned it, it's starting to get her down if I'm honest.

Perhaps get in contact with the www.childgrowthfoundation.org/ for some advice? Treatment for growth disorders can be very variable in the UK.and usually takes alot of parental pushing for medical assessment.