Should I Be Concerned About My Son's Growth Pattern

[amw4013]

My son, Ryan, turned three on 3/25/08.  I took him for is annual check up on 4/1/08.  He measured at 33 inches and weighed 27 pounds.  When our pediatrician plotted his measurements on his growth chart she was very concerned.  Ryan has always been at the bottom of the chart, but this year he completely fell off of the chart.  I have noticed this at home also.  He has been wearing size 18 months clothes for over a year and a half.  His sandals from last summer still fit him perfectly this year.  I come from a very tall family, but my husband comes from a very short family.  I am 5'6" and my husband is only 5'3".  I understand that my doctor would not be as concerned if Ryan was "just short".  I understand that her concern comes from the lack of growth, but I just can't help but wonder if this is just normal for him considering the size of my husband and his family.  Also, I'm not sure if this has any affect, but I was diagnosed with autoimmune thyroid disease after I had Ryan.  I was not diagnosed during pregnancy, but suspect that I did have the thryoid problem during the pregnancy given the symptoms that I was having.  We actually have an appointment with one of the pediatric endocrinologist at Vanderbilt, but we were not able to get in until 9/29/08.  That just seems like such a long time to wait.  Should I be pushing to try to get in quicker, or maybe get an appointment with another doctor that we can see sooner?  Also, what can I expect at the first appointment?  Will they immediately start testing, or will we set up subsequent appointments for that?  One of the things that I have read that really concerns me, is that sometimes these growth disorders are caused by a tumor on the pituitary gland.  Do you have any statistics on that?  How often is that diagnosed in situations like these?  Thank you so much for your time.

[Deanna L Aftab Guy, MD]

you are fine till May, I usually do a full blood test and a complete history and physical and a bone age at the first visit. Then next visit is nothing just measurement and we will go from there, see you soon. Aimee is a friend, she is an excellent pediatrician, she will not steer you wrong!

[amw4013]

Thank you so much for your reply.  As it turns out, I spoke with my pediatrician, Dr. Aimee Perry @ Centennial Pediatrics, and she didn't want us to wait that long to see Dr. Mathew (that is who our original appointment was with).  I am now scheduled to come to your office in Cool Springs on 5/20.  Do you feel that this is a more appropriate length of time to wait?  Also, could you explain what we can expect at the first appointment?  Do you usually start running tests or will there be a period where we just watch is growth for a while?  Thank you again for the time you take to answer questions here.  This has been something that I have been very worried about since his doctor thought that there might be a problem.  I have learned a lot from reading some other posts on the site.  

[Deanna L Aftab Guy, MD]

ok, 3 yo boy who is 33 inches and 27 lbs is at the 25th percentile for weight but under the 3rd for height-your height and your hubby's put his height below his normal range, you mentioned you have an appt at vanderbilt in September, please have your doctor call again and either talk to the on call doc or call our office to get put on the "waitlist" -this will get your appt moved up.Also your own doctor can do the following to help the specialist-bone age, bloodtests to include free T4, TSH, cbc, cmp, somatomedin C (also called igf-1), this information will set your mind at ease and will direct the need for sooner care appropriately. Maybe you will see me!!!

[amw4013]

Thanks, Rachel.  I know how scary it can be to be told that there might be something wrong but not know what.  Like I said in my post, my husbands family is very short, so that gives me a little bit of hope.  I also know, though, that it is not normal for a child to not outgrow shoes or clothes for almost two years.  I am not a patient person:)  I hate wating to even see the doctor, & then when we get to that point I know that we will have to wait for tests and results.  My prayer right now is just that if there is something that is causing this, that it is not something very serious or life threatening.

[Rachelinpain]

i know i am not a doctor but since we are both waiting for a response, just thought i would say hi, as we both have the same question (see my post below yours "when to push for endocrine referrel").  my daughter is 3 and like your son, is small (34 inches, 23 pounds).  she has been seeing a gi doc for over a year and he keeps threatening to do a g-tube.  she continues to make tiny gains (about 100 g a month on super high calorie diet) and all of her testing so far has come back normal.  she fell off the growth chart a while ago.  I have a 2 yo little girl also and they share clothes and my 2 year old outweighs her significantly.  now that my 3 year old is wearing panties instead of diapers i can not even get her pants to stay up anymore.  i guess i am just wondering how many times doctors say "she will catch up" until they actually do anything.  well i hope you have great success in getting a diagnosis.