Letter from Public Health Nursing to say they want further contact ref height/weight - worried... :-(

[Katnisscupcake]

DD is 4.4 and VERY small for her age, but then she always has been.

She's only 93cms high and weighs 14kilos.

But her red book shows that she's always been small and the centiles she's on have always fluctuated. She's been between 2nd-9th since she was 12 weeks old and has been anything from 25th centile down to 0.4th from about the same age.

She's also had 3 operations (two eye ops and gromets) and all her development checks and they've always just said that she's small. They haven't been concerned.

She appears to be quite bright (reading at Level 3 and doing very simple mathematics) and at school they've said that her gross motor skills are exceptional (handwriting, drawing etc) so there are no developmental issues in that regard, but every time I see a 'referral' for anything I just panic.

As a baby the weight/height thing used to stress me out soooo much that we only took her for the set developmental reviews (1 year, 2 year etc). They all said that she's fine, just small.

What will happen now, does anyone know? DH is 5ft 7 and I'm 5ft 8. But DH's Mum was only 5ft and his sister is 5ft 2. DD looks very much like DH's side of the family, will they take this into account? Or because they haven't seen the red book, once they say that she's always been small, will they just let it go?

My now 6yo ds2 was 97cm and 13.7kg just after his fifth birthday. Dh and I are both small, which helps in our case. We did have growth hormone mentioned when ds1, who is now on the short side of average albeit v skinny - IIRC the main growth spurt came when he was 6 or 7ish -, was 2 and tiny, but it was presented more as a 'cosmetic' choice than as anything we need to do out of medical need. My 5ft 2ish dh is a great example of how to wear lack of height well - he was v sporty when younger, is quietly confident, high achiever, successful career - so we would much prefer to go down that route than meddle with their hormones.

I'm 5ft 1 and yes, would prefer to be taller if I had the choice, but I know tall women who are very self-conscious about it. It's very individual.

Katniss - Don't worry, not too personal at all! No, I'm glad that my parents didn't go down the growth hormone route. I think medicalising the issue of my height would have given me much more of a hang-up about it, especially as I was only perhaps three or four inches shorter than my peers. That said, there was another girl in my primary school class who was noticeably smaller than me; she had a developmental condition, and I do remember her being the target of more comments/teasing than I ever was. Not sure how I'd have felt in her position.

In all honesty being below average height-wise has occasionally been a pain, but only on a very low level. A few random examples that spring to mind: always ending up at the back when we lined up in order for class photos; being the one who was always asked for ID in pubs as a teenager (exacerbated by looking young for my age, although that aspect is becoming increasingly welcome as I get older! ); constantly being described as 'cute' (I do think petite people do have to work that bit harder to be taken seriously) and, in crowd situations, being the one who gets trampled on/elbowed aside because people simply don't notice you - I live in London, and Oxford Street can be a nightmare in this respect, but then Oxford Street is a nightmare in many respects! Other than that, it's had no bearing on my life whatsoever, and my friends who are taller than average have experienced far more problems in terms of being viewed as 'different'.

I view being short as a minor annoyance, like having bushy eyebrows or big feet, rather than a significant problem. As you say, most people are never completely happy with every aspect of themselves! I certainly don't see it as any kind of disability - there are very many people out there who have to put up with much more serious problems. In all likelihood there's nothing to worry about and the referral is purely routine. There's no harm in letting your DD attend the appointment so they can rule out any other health issues. Then you can take any other decisions from there. Your DD may well end up having a sudden growth spurt later on anyway!

Should have said that in the context of my ds2 I don't think 93cm is worryingly short tbh. Short, yes, certainly. By all means follow up the referral. You seem to be worried you will be forced into something you don't want and that's not good for your child - I would communicate that fear clearly during the contact.

Picardy and Tenth thank you both so much for your posts.

I am going to take up the referral and have actually been given the contact number today to call the school nurse team, so I will do that and discuss what they envisage as next steps.

DD has always been referred to as 'cute' and she did have a friend (a month younger) who used to pat her on the head which she didn't appreciate. Unfortunately her size has, in the past, been coupled with the fact that she used to be shy and quiet. That is very quickly becoming a non-issue though since she started in Reception as her confidence has improved dramatically and she has a lot of friends which has helped that confidence to grow.

Picardy, thank you for your last point, that is exactly right. I do worry that we will be forced into doing something that is not right for DD.

Tenth, your post has given me a lot of food for thought. I have never been happy being tall.

Having said that, when I started in Secondary school, I was so small that I was pulled out of class by the care-taker to make sure that I could reach the new locks that were being put on the toilet doors, so I guess I was a late grower aswell.

My Mum doesn't remember me being particularly small, but maybe I was...

Yes, Katniss, the 'cute' thing can be a pain; I do have memories of being the child in Reception/Year 1 that everyone wanted to pet and pick up because I was so small - a bit like being the class mascot! On the plus side, being constantly manhandled every break and lunchtime did make me become quite feisty and willing to speak my mind - as you say, it has a lot to do with confidence.

Oh, and I've just remembered that my school sixth form head of year was 4 foot 10, and hugely respected and authoritative - so it very much depends on the person!

Tenth you're right - she did start shoving her friend's hand away and because she couldn't open her left eye properly, it looked like she was giving her an evil stare . She can't do that now she's had her op!

My DBro's GF who is also petite said that she was never short of friends as everyone looked after her and no-one ever picked on her. So she didn't get the opportunity to get too feisty!

So I guess there are advantages and disadvantages, I guess it's how you 'work the crowds' .

Katniss- we are against growth hormones aswell. I am small and dh on the shorter side . I remember being called 'cute' but was ,and never have been, unhappy with my size. My mum keeps saying ds2 will be unhappy when he is older, but I don't agree that height is a recipe for happiness or unhappiness- that is down to a lot of other factors that we try ( but don't always succeed) to put into place.

However, ds2 has a heart condition aswell as his other conditions and is often at the hospital- I do feel for him, think 'why him' and hate taking him for blood tests. So I do know how you feel. Hope your dd doesn't have to have another op anytime soon.

I very much doubt you'd be offered Growth Hormone just because a child is genetically small for no other reason.

It is incredibly expensive and would normally be offered to children with confirmed GH deficiency or an inability to absorb their own GH, usually as a result of a medical condition or genetic disorder.

OP hopefully your DD will just be monitored and will grow nicely, just be very petite

Missmapp, it's horrible isn't it . When she had her op on Friday and they couldn't get the cannula in her hand (I'm sure most of us know how painful those things can be - even with magic cream) I felt so helpless as she screamed in pain and then when they brought the gas mask to her face it was just awful. When they look at you with that 'help me Mummy' face.

Luckily she's fine now. Swollen and bruised around the eye but so much better in herself. We've got 13 of her friends coming around on Thursday for a halloween party and trick-or-treat so that will cheer her up [hsmile].

I hope that your DS is OK.

Sidge, Thank you for that. I'm prone to over-reacting and constantly feel wracked with guilt for everything DD goes through, but I'm definitely starting to feel much better about it after all the reassurances that I've been given.

My daughter has growth delay. Should be on the 97th centile and is on the 4th.

She's been seeing the paediatric endocrinologist for 1.5 years now. She is missing an endocrine growth factor (IGF-1), but her bones make enough that she is growing.

We had all the tests for growth hormone done and they were fine, so we're on a watch and wait schedule with appointments now every 12 months instead of every 3.

She's very healthy and energetic - just small.

However, if a child does have growth hormone deficiency, there are very important reasons to have it treated - the height issue being only one of them. Growth hormone is very important for muscle development and bones as well as a host of other things.

It costs over £20k a year to treat a child, so they make you jump through a lot of hoops to qualify - not something the NHS does for the sake of a couple of inches.

Your DD may well be following a familial pattern in which case, all is good but best to be on the safe side.

Initial appointments, they generally do a set of blood-tests, looking at thyroid, IGF-1 and since she's a girl they may well do a karyotype to rule out Turners Syndrome/Mosaic Turners (takes about 6-8 weeks to get that one back).

They may also do an x-ray of the left hand and wrist to check bone age. My DD's bone age at 3 was that of a 2 year old which wasn't too bad.

They also do some very exact measurements of her height.

Hope the appointment goes well - I used to bribe DD with a trip to McDonalds afterwards for cooperating with the measuring.

We are on the opposite side to you... DS off the chart for weight at 9 months. His weight was following 98th then jumped, his height is 75th. At 9 months he weighs 11.2 kg and 78 cm long. Every time I see a HCP his weight is raised as an issue and we get the 10th degree. he was born on 25th for weight but off the scale for length/height, essentially it looks like he just chubbed up massively and slowed down height wise.

However... DH is 6'2. My dad is 6 ft. My brother is 5'11. I am 5'7. We are not a short family!! Anyone looking at the bigger picture would soon see how DS fits in, but so oftern they just look at the measurement in front of them. It drives me mad and I agree it can feel "them and us", almost like you're defending your own child. Sorry you are going through this and your Dds eye operations. No practical advice, but you know your Dd and she sounds absolutely fine.

Luckily we can rule out turners because i had an amino when i was pg and they tested for it.

I am now waiting for a call back from the school nurse team.

My eldest at that age was a little taller but only 12kg. He was constantly being flagged up for review and referral. Eventually they declared him 'small but healthy' He's now a perfectly normal 5'11.5" (desperate to grow a tiny bit more!) 19 year old who is very slim but perfectly healthy.

I've had this letter for my daughter but we have the option where we can opt out if we want to. I'd try speaking to the school to see if you can opt out.

We had this letter for my daughter in Reception. She weighed less than your daughter, though she was slightly taller (but six months older). They asked me to ring them to discuss, so I did and explained that I am also pretty skinny as is her dad and neither of us is tall (DH just below average, me just above). They said they'd weigh her again next time they were at her school, though I don't think they ever did, and we've heard nothing back at all.

Just an update on this...

Went to the GP on Monday to ask for a referral. She looked through DD's red book, said that she's always been small and she doesn't think that there's anything to worry about at all, but has made the referral for my peace of mind. She said once the Pediatrician has seen her and said she's fine, that we can tell the Public School Nurse team that we no longer want or need any involvement from them.

I did however show the GP the cellulite that DD has. I started a thread on this a long time ago. A lot of people on the thread at the time said that it was just dimples etc but it was difficult to express how bad it was without putting on a picture which I didn't want to do.

GP said that she had NEVER seen that on a child before and that it was definitely something that I should raise with the Pediatrician. She's had it from the day she was born and I always thought she would grow out of it but she hasn't. In fact it looks worse now and covers the trunk of her body from her chest down. Considering that DD is no way over-weight it's very odd...

Anyway, just wanted to update for all the lovely people that offered me support.

I think it's a 3 month wait for an appointment but it'll be worth it to close this down once and for all.