Assessing Growth and Leg Issues in Young Children: What to Expect

Height and foot shape issues?

My son is 3 years and 2 months old, but his height is only 92 cm and his weight is only 12 kg (he weighed 11 kg at 18 months).
I want to take him for a growth assessment, but I'm unsure if this evaluation requires blood tests or any other procedures that might cause pain for a child.
Additionally, my son seems to have an issue with bow legs; will the doctor also evaluate his leg shape during the growth assessment, or should I take him to see an orthopedic specialist separately? If I need to see an orthopedic specialist, should it be a general orthopedic doctor or a pediatric orthopedic specialist?

Haizi de ma, 20~29 year old female. Ask Date: 2010/02/24

Dr. Xiao Kaiwen reply Pediatrics

A 3-year and 2-month-old boy has a height of 92 cm and a weight of 12 kg, with percentiles ranging from 3% to 15%, indicating that he is relatively small for his age.
It is advisable to consider a growth assessment.
You should prepare past growth charts (from the health booklet), the height and weight data of the parents, and information regarding his dietary habits, among other things.
If tests are needed, they may include a hand X-ray for bone age assessment and blood tests for hormone levels, which may cause some discomfort for the child.
If there is a suspicion of bow legs, it would also be appropriate to consult a pediatrician, but it is recommended to seek a second opinion from a pediatric orthopedic specialist, as they may have more expertise in this area.

Reply Date: 2010/02/24

More Info

When assessing growth and leg issues in young children, it's essential to understand the various factors that contribute to growth patterns and potential concerns. Your son, at 3 years and 2 months old, is on the shorter side for his age, with a height of 92 cm and a weight of 12 kg. While growth can vary significantly among children, it is crucial to monitor growth trends and seek professional evaluation if there are concerns.

Growth Assessment
To evaluate your child's growth, a pediatrician will typically conduct a thorough assessment that includes measuring height and weight, plotting these measurements on a growth chart, and comparing them to standardized growth percentiles. This helps determine if your child's growth is within a normal range for his age.
In terms of tests, a growth assessment may involve:
1. Physical Examination: The doctor will perform a physical examination to assess overall health and development.

2. Growth Chart Analysis: Your child's height and weight will be plotted on a growth chart to see how he compares to peers.

3. Bone Age Assessment: If there are concerns about growth, the doctor may recommend an X-ray of the left hand and wrist to assess bone age. This can provide insights into whether your child is growing at a typical rate for his age. This X-ray is generally painless and involves minimal discomfort.

Blood Tests
Blood tests are not routinely required for a growth assessment unless there are specific concerns about nutritional deficiencies or underlying health issues. If the doctor suspects conditions such as hormonal imbalances or chronic illnesses, they may recommend blood tests to check for issues like thyroid function, growth hormone levels, or nutritional deficiencies.

Leg Issues
Regarding your concern about your son having "X-shaped legs" (also known as genu varum), it is advisable to discuss this with the pediatrician during the growth assessment. The doctor will evaluate his leg alignment as part of the physical examination.
If the pediatrician identifies any significant issues with leg alignment or if there are concerns about his growth pattern, they may refer you to a pediatric orthopedic specialist. Pediatric orthopedic doctors specialize in musculoskeletal issues in children and can provide a more detailed evaluation of leg alignment and any necessary interventions.

When to See a Specialist
If your child's growth is significantly below the expected range for his age, or if there are concerns about his leg alignment, it may be beneficial to consult a pediatric orthopedic specialist directly. This can be done in conjunction with the pediatrician's assessment.

Conclusion
In summary, bringing your son for a growth assessment is a proactive step. The pediatrician will evaluate his growth and leg alignment, and if necessary, recommend further tests or referrals. It's essential to address any concerns early, as early intervention can be crucial for optimal growth and development. Remember to keep an open line of communication with your healthcare provider, and don't hesitate to ask questions about your child's growth and development.

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