short but lovely daughter

[lawmom3]

Good morning. My daughter was a premie  (33 1/2) weeks gestation and 2 lbs 15 oz at birth.  Small brain bleed, resovled, no other complications.  PCP thinks she should be fully caught up. She's just had her 10 yrs old well visit.  SHe's always been short but her place on the charts has fallen to 20th percentile.  I think she's 4'3.  PCP asked what heights myself and husband are (5'6 and 5 11 3/4)  Other men in family are short with 3 being 5'8 or so.  PCP a bit concerened due to my husband and my height.  My assignment has been to get family members heights reported to her.  If she is not satisfied that my daughter hasn't just caught the short gene,she may refer her to be seen by a specialist to consider HGH.

Insight?
  

[Deanna L Aftab Guy, MD]

Work with our pcp to get information, our on call doctors get phone calls daily to review the labs and growth curves and we can tell your pcp if referral is needed. I usually say yes unless it is for something normal. So if you are in our neck of the woods ask your pcp who probably knows us to call our on call doc and discuss it.
Or if you have a peds endo closer that would be ok too.
If you are worried that is enough reason, moms are always right!

[lawmom3]

It seems that a referral from the PCP is required to get an appt.  My PCP doesn't think it needs further workup......???????

[lawmom3]

The homework assignment resulted in the following heights:  my father 5"8, my brother 5 7 3/4 and my husband's father, 5"9.  These are short men.  PCP now thinks she just caught the short gene from them.  Do you think her low birth weight may be an indication?  Like I said earlier, my husband and I are 5"6 and 5 11 3/4.  

I am right here in your neck of the woods and don't require a referral for specialists.  My PCP is phenomenal, but do you think I should check into this matter further?    Your time and opinion is very much appreciated.  

[Deanna L Aftab Guy, MD]

I agree that she needs to be assessed, children should not decelerate, if they are late bloomers or just genetic short stature they keep their curve on the low end but acceptable range, when a child decelerates below the genetic range they may indeed have growth hormone or thyroid hormone or other problems, even celiac disease. With her being premie and born at 2 lbs 15 oz. she is actually under the category of small for gestational age and actually qualifies for growth hormone for the SGA diagnosis which is an fda approved indication, usually these are kids who don't catch up after 3 years , but yes, she needs workup, maybe not extensive but the first steps which include a cbc, comprehensive metabolic profile, TSH, free T4, celiac antibodies a bone age xray and a karyotype which is genetic testing that is important in all short girls to be sure all the chromosomes that are important for growth are there-rare disorder called Turner syndrome may be hard to tell and the testing may help.
Yes, get referral, where are you located, perhaps I can give a few hospitals