Growth Concerns: When to Seek Endocrine Evaluation for Your Child

Growth curve below the 3rd percentile?

Hello, doctor.
I would like to inquire about my child, who is over one year old and has been receiving vaccinations at the clinic.
The doctor has measured his growth curve, which is consistently below the 3rd percentile.
He is currently two years old, measuring 87 cm in height and weighing 11.5 kg.
In recent months, we have been measuring his height, and he has been growing an average of 0.5 cm per month.
Given this situation, should we consult an endocrinologist at the hospital?
Regarding his sleep, he usually goes to bed around 11 PM and takes a 2-hour nap during the day.
His diet is not very good; he doesn't eat much, but he does have formula milk.
Throughout the day, he eats little with adults and also drinks fresh milk, although not in large quantities.
One concern is that he does not eat eggs.

Could this possibly indicate dwarfism? Both my husband and I are of normal height, and our child's teething, walking, and speech development are all normal.
Thank you, doctor.

Li Mama, 0~9 year old female. Ask Date: 2022/10/07

Dr. Xiao Kaiwen reply Pediatrics

A two-year and ten-month-old boy with a height of 87 cm is below the 3rd percentile.
Being below the 3rd percentile warrants a consultation and evaluation at a major hospital's pediatric endocrinology department.
Whether he has dwarfism can be determined by a specialized pediatric endocrinologist.
Typically, dwarfism is characterized not only by short stature but also by a disproportionate appearance with short limbs.

Reply Date: 2022/10/07

More Info

When it comes to understanding growth concerns in children, especially in the context of your child's growth measurements and overall development, it is essential to consider several factors. Your child's height and weight measurements indicate that they are below the 3rd percentile for their age, which is a significant concern. Given that your child is currently 2 years and 10 months old, standing at 87 cm tall and weighing 11.5 kg, it is important to evaluate whether these measurements are indicative of a potential underlying issue.

The growth rate you mentioned, averaging 0.5 cm per month, is relatively slow for a child of this age. Typically, children in this age group should be experiencing a growth rate of about 5-7 cm per year. While some children may grow at a slower pace and still be healthy, consistently low growth percentiles warrant further investigation.
Your child's sleeping patterns, dietary habits, and developmental milestones are also crucial to consider. You mentioned that your child sleeps around 11 PM and takes a 2-hour nap during the day. While sleep is important for growth, the quality and duration of sleep should be assessed to ensure it is adequate for their developmental needs.
Dietary intake is another critical factor. You noted that your child has a poor appetite and does not eat much, which could contribute to inadequate nutrition and, consequently, growth issues. A balanced diet rich in essential nutrients, including proteins, vitamins, and minerals, is vital for healthy growth and development. If your child is not consuming enough calories or nutrients, it could hinder their growth potential.

Given these concerns, it would be advisable to seek an evaluation from a pediatric endocrinologist. An endocrinologist specializes in hormone-related issues, including growth disorders. They can conduct a thorough assessment, including growth hormone testing, bone age assessment through X-rays, and possibly other metabolic evaluations to rule out conditions such as growth hormone deficiency or other endocrine disorders.

As for the possibility of dwarfism, it is important to note that there are various forms of dwarfism, some of which are genetic and others that may be due to hormonal deficiencies. The fact that both parents are of normal height and that your child is meeting other developmental milestones (like walking and speaking) may suggest that there is no immediate cause for alarm. However, only a medical professional can provide a definitive diagnosis.

In summary, while your child is currently developing normally in some aspects, the combination of low growth percentiles, slow growth rate, and dietary concerns suggests that a consultation with a pediatric endocrinologist is warranted. Early intervention is crucial in addressing any potential growth issues, and the endocrinologist will be able to provide guidance on the next steps, including any necessary tests or treatments. It is always better to err on the side of caution when it comes to your child's health and development.

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