Very small child growing little

[elelulu]

Hi everybody,

I am the muum of a 16 months old girl.

When my daughter was borne, on term, she was tiny: 2,066 kg (4 pounds 9 oz) - although both me and her dad are quite tall and I do not smoke (nor did I during pregnacy) did not have high blood pressure, no infections and so on - so: no reason at all to justify the tiny size of our baby.

She, now 16 months, is 7 kgs and 70 cm tall, which is still VERY small for her age.
Apart from her size, she is fine: healthy, lively, happy and so on. She has always been very sparkly and done all the things a baby of her age is supposed to do. She is quite a fussy eater (gets bored very soon, so she does not eat much).

She has been followed by a NHS pediatrician, and was tested for cistic fybrosis - with negative resuls. Her urines were tested to see if she had some infections - also negative.

I have recently been to a private pediatrician to have her growth hormone tested and also to have her tested for the celiac disease. He said that there is no use in having these tests done before she is two years old, because they are not realiable.

I had her wrist x-rayed, to determine her bone age. The result was that her bones are immature, the bones of a child younger than 12 months. Her pediatrician was not concerned by this and just said to wait until she is two to have her other tests done (growth hormone, celiec antibodies and also a cromosome read, to rule out turner disease).

I regularly consult a pediatrician in Italy as well (where I come from) and she told me that such a big delayed in bone development must be investigated - now, not when she is two.

I am pretty confused about these different attitudes, and I would like to ask other parents with similar problems what they approach has been.
Again, I am a tall woman and my daughter's father is also quite tall - so we would really like to understand why our baby is so tiny. And I especially would like to know why her bone age is so behind.

Thank you

my son is like this and always has been and I have worried myself sick over it.He is full of energy and is now 10 and still little but is happy and healthy.My dp tells me that I should let him be and so I have but I realise how you feel.Maybe you should wait til she's at nursery because then you will see the huge variation in size of the children,there are some giants and some teenies amongst my son's friends so I try not to worry now.HTH maybe she is catching up from low birth weight

My dd was similar weight at birth but I did have problems with dd being born early, she is not big now but petite for her age although she is shooting upwards.
I think I would be confused about the conflicting advice you have received.
I think it could be wise to wait before putting dd through the tests. I too was small for my age when I was born and under went tests -nothing wrong I may add. Don't worry too much at the moment. larsxx

I have e-mailed your posting to my dad, who is a retired paediatric radiologist to see if he has anything to comment.

I believe that one of the areas that he had a particular interest in was bone age.

It'll be at least a day before I get a reply though - he was pretty "non-interventionist" though, so he may also advise not worrying for the moment.

My DD2 is 2 and a half, weighed 3lb 8oz at birth (was born at 33 weeks) and weighs about 11kg and is only about 79cms tall, I am small myself though.
Hope you get the answers you need

elelulu
your dd sounds very similar to mine, my dd has a genetic syndrome, she has just started a supplement called paediasure and has put on 3/4 kgs in 5 wks and now at 18mths is 8.45 kgs or 18lbs 10oz.
Have they checked for any genetic syndrome or otherwise causes?
Pls do email me if you need anymore info about features and things, I am not trying to frighten you, my dd is VERY healthy and happy and developing well for her size, the syndrome my dd has is Noonan Syndrome, low weight gain and small stature are a feature as can be bone density age.
It is in most cases a failry ordinary issue, but worth checking out.
This is only my opinion, please it may not apply to your dd of course.
m7 dd 1s 74cms at 18 mths

I can understand how worrying this can be as my daughter needs to be treated with thyroxine hormone for congenital hypothyroidism. There are different opinions in different countries about treatment for this condition too (to do with initial dosage), although our NHS paediatrician has explained the different approaches and I feel more reassured now. I would imagine there is some controversy about treatment for growth disorders. Is your private paediatrician an expert in endocrinology? Good luck, hope someone else has some more relevant experience on this problem.

Thank you very much all of you.

Piffleoffagus, thank you for sharing your experience. The paediatrician wants her to do a genetic test when she is 2 - to rule out turner disease. Do you know if turner disease is related with Noonan? I have had a quick look on the web and the symptoms seem pretty similar.

JanZ, thank you for having forwarded my posting to your dad - I am very interested in knowing his comments.

Please keep posting to me with your comments and experiences. It is very informative and also reassuring (especially on a day when I feel very low...)

hi, elelulu.

Like you I am tall and had a tiny daughter first time round. She weighed 5.11, and was also tested for cystic fibrosis, because of "failure to thrive" - in fact this was because I was trying unsuccessfully to breastfeed and she was fine once we switched to formula. We never had any bone tests done so can't compare there.

She remained tiny throughout childhood and was always the smallest in her year, below the 10th centile. When she went to secondary school at 11 she was c 138 cm, 4'6 - her younger brother was this height at 8½! (I will see if I can find her baby records later to see how tall/long she was at 16 months).

Anyway, to cut a long story short, she is 22 now and after she eventually had her teenage growth spurt, she ended up at 5'7. Still quite short with a 6' mother but not a bad height! (Her younger sister, who was 75th centile throughout, is also 5'7. Go figure.)

Obviously having had the bone test done you need to follow through but there may not be a problem. Good luck.

Haven't got a 16-month record - at 12 months she was 73cm and 20lbs 4oz (9kg); at 21 months, 82cm and 23lbs (10.2kg). Pro-rating that, at 16 months she was probably c 77cm and 9.5kg, so a bit bigger than yours, but then she started out bigger too.

She was born slightly over term btw - at 41.3weeks.

This is the response from my Dad:

"Children vary hugely in their size as you know and bone age is not a very accurate method of estimating maturity - but it gives an indication and there are a multitude of causes of delayed bone age -from genetic causes to a host of medical causes, which I would imagine any competent medic would have considered - that after all is what the milestone assessments are meant for. From the e-mail it would seem the baby is mentally O.K. (What parent doesn't think that?) plus she doesn't eat too well (What parent hasn't had those doubts?). She really needs to trust her medical advisors - she seems already to have seen a NHS paediatrician who is is unlikely to investigate unnecessarily and a private paediatrician who seems to have given the same advice, so I can't see (without an awful lot more information) why she doesn't wait until the child is two as she has been advised before further investigations are instituted. "

He's a wee bit more cynical about the Italian opinion - in the absence of additional information, his comment is "As far as the Italian view is concerned you would need to establish whether the opinion was given by a specialist paediatrician or a general practitioner specialising in children (Italy was oversubscribed in terms of doctors and they all need to make a living- if you get my drift)."

Essentially he says you should be patient, relax and trust the two professionals you have already seen in this country who presumably have the most complete picture of your dd.

For info, dad's comment about "children varying in size as you know" is because my own ds started on the 91st centile for weight and dropped through them until he was trundling along just underneath them at about 6 weeks - yet he was always happy, healthy and alert, so dad was never concerned - and neither was the consultant paediatrician he was referred to by the midwives at the b/f support group just to cover themselves - he was more interested in knowing what my dad was up to than the manifestly thriving, albeit light, baby in front of him. Dh's view had always been "until your dad is worried, I'm not worried..... if he though that there were anything wrong with his first grandchild he's have him off to his former colleagues at the Sick Kids pronto" - which helped give me the confidence to continue to bf. He eventually (at about 3 months) started to move back up and roughly followed the 25th centile (as predicted by the paediatrician) and then moved up to about the 50th centile which is where I think he still is at 3 years 9 months (but I don't know - I don't weigh him anymore - he looks healthy so I'm not bothered).

In his PS he also says that the birth weight wasn't that low. But then, he did work at a specialist hospital where they dealing with very sick, premmie or multiple babies. I was in to my 20s before I realised that babies were supposed to be more than a couple of pounds at birth, as when even multiple births were mentioned on the news and the weights were more that about 1 and 1/2 pounds, Dad would say, "they'll be fine"

Dad's wording may be a bit blunt, but I hope that it reassures you.

elelulu, I was 4 lb at birth, and between the ages of 6 and 12 months had numerous tests at Great Ormond Street to find out why I was "failing to thrive". They never did find any thing wrong, and I am now a perfetly healthy 40 year old. Only 5'2" tall, but I don't feel like a midget!

elelulu, there area lot of advantages in being diagnosed early if it is a syndrome, and not leaving it later. My dd has not had any "major" investigations at all, nor excessive intervention, infact the opposite, we have ahd calm confident doctors throughout who knew their stuff,
noonans babies have a heart defect, varies from major to minor, this is often the reason for failure to thrive, heart working too hard for the number of calories a small baby cna take in each day, but I imagine a murmur would have been spotted by now with your dd. Without the heart is is not as likely to be Noonans though.
Turners is often mistaken for NS and vice versa.
A skilled geneticist should be able to spot the syndrome face to face, then they can further confirm with a blood testm my dd had this done at 8 months and was negative but still has the syndrome. I would urge you to seek out a genetic opinion earlier, as if it was something like Turners or Noonans there are steps you can take to improve the growth and physical development and then you can also turn to dedicated support site for info.
If I cna be of any more help pls let me know, where are you based?

Thank you all.

Thanks JanZ for your dad's opinion. The Italian doctor is actually a paediatrician - in Italy children are seen only by paediatricians and not GPs (the medical system is quite different).

Piffleoffagus, thanks again - I am based in Buckinghamshire, moving soon to Berkshire (hopefully our house purchase will go through). My daughter apparently has no heart murmur, nor she seems to have the other symptoms which I read on the web sites of noonan - but the extent with which these symptoms manifest varies quite a bit, therefore we will have her tested.

I think I will look for an endocrinologist, as both muminlondon and the italian paediatrician suggested.

Thank you tissy, your posting made me smile.

Thanks janh for the your daughter's growth records - she was quite a giant in comparison with my baby .

Well, I will carry on with the tests and see - I do not mind her being tiny - only want to know if there is any reason I should worry about.

In the meanwhile, if anybody has something else to share on the topic, I would greatly appreciate.

do ask about paediasure, the supplement, it has made an enormous difference to dd;s muscle tone, strength and weight gain, leaps and bounds in just 5 weeks. It is on prescription from GP!
Awesome stuff really and truly.
I am happy to email you a photo of my dd at 16 mths to compare features if you wish?
If you like I'll do it via contact another talker
Cheers and good luck
piffle

Piffleoffagus,

thanks for the info on paediasure.

I have had a look at many web sites about noonan - I saw many pictures of baby and children. Therefore there is no need for you to email me the picture of you baby, but thanks very much for the kind offer.

I will ask to be referred to an endocrinologist and also to do the genetic tests.

My son is very small for his age - 4lb at birth (36 weeks), on the 0.4 centile where he has remained. He is now 3.5 and wearing clothes for a 12-18 month old. He had all the blood tests which came back fine at around 18 months. When he was 2 he had the bone scan and this revealed that his bone age was a year behind his actual age. His paediatrician 'diagnosed' a general growth delay, but emphasised that this is not a condition as such, just a variation on normal growth.

His height is now plotted as if he were 12 months younger and using this method he has suddently jumped to almost the 50th centile!

Children with delayed growth tend to hit puberty a few yeasr later than their peers, obviuosy more noticable in a boy so we're aware that ds may have problems being picked on as he gets older. However their growth does catch up in the end - rather than stopping growing at 18 or so ds is likely to still be growing while he's at university (!) to reach his eventual adult height.

This is a relatively common condition, and I'm sure that if your paediatrician suspected a genetic disorder you would have had the tests by now. As her bone age is obviously less than her actual age this is the reason for her smallness. If you measure against a child of the same bone age she will probably not seem that small!

BTW the delay gets larger - my ds'bone age is a year behind. By the time he hits pubrty it coudl well be three years behind, so at 16 he willbe the height of an average 13 year old. Bu they do catch up!! So don't worry!!

thanks for the info titchy.

I also wanted to ask something else - my baby sweats a lot, particularly at night, and particularly (if not only) from her head. I know these days the weather is quite hot, but last night she wore a light pijamas and had only her sheet on top, and she was sweating.
Is this sweating a symtom of something? I have never mentioned it to any paediatrician but maybe I should.

Hi there’ I know it’s an old post but my daughter sounds very much similar to yours and I’m in the UK too. Especially with the sweating thing and low percentile for height and weight. How did it evolve for you? 😊