Would you be concerned?

[corgimom]

DD had her 15 month appointment on Monday. DH took her because I had a conflicting appointment and he said all went well - she's still small but growing on her own curve, meeting or exceeding developmental benchmarks and looked healthy! She got some shots and the doctor put in an order to do some bloodwork which she said was standard for this age (Iron, Lead, Vitamin D, etc).
I called the office on Tuesday to see if the order was in so I could take her to the lab later in the week and the receptionist mentioned it was strange that the doctor had included a thyroid check in her blood work but it was probably because of her size. DH said the doctor stated she wasn't concerned about DD's size because she is always growing and she is developing well. So I sent a message to her doctor and she said she mentioned she had included it because of her size and she's not concerned, per se, but rather because she's already having blood work so it doesn't hurt to check just in case.

DD is 16 pounds and just over 27 inches tall at 15 months. She is tiny and has been since she was born. She's less than the first percentile but has always grown and gained on her own steady curve so I've been told not to worry despite the constant comments from people on her size. I also know two other folks with kids who were and are still small but are healthy so I know I shouldn't be concerned... but she is by far the smallest in her class, people always mistake her for being much younger than she is and now the doctor threw in this test to her blood work.
I really shouldn't be concerned, right?

[ohgillian]

I wouldn't be super concerned about the inclusion of the thyroid test - presumably her thyroid was normal on her newborn screening panel, and even if it turns out to be problematic now, typically that can be treated with medication.

However, at less than the first percentile, I'd personally ask the pediatrician if a consult with peds endocrinology is indicated. (And I'd want a good explanation of why it *isn't* indicated.) It's good that she's keeping steady with her own curve, but at the same time, I wouldn't want her to stay on that same curve into adulthood.

[shauni27]

I would not be concerned at all. Sounds like she is just a tiny kiddo and the doctor is just covering all basis since bloodwork is already being done.

We have two friends with babies one month apart. The older baby is 9 months and weighs 17 lbs. The 8 month old weighs 23 lbs. They both see the same pedi and she is not concerned about either. They are both following their own curve.

[hermione]

0 concern. The doctor was clear since they are already taking blood, she just threw this in. If the doctor was concerned, she wouldn't hide it from you. That's not how it works.

[corgimom]

Thanks, all! Logically, I know not to be concerned but the emotional part of me doesn't always play along especially when it comes to my baaaaaby, hah!

[Waffles]

I wouldn't be concerned, and if anything I would be glad the doctor is being thorough/taking advantage of blood being drawn anyway to make all the checks.

[Ashley&Scott]

Aug 21, 2019 8:38:27 GMT -5 Waffles said:

I wouldn't be concerned, and if anything I would be glad the doctor is being thorough/taking advantage of blood being drawn anyway to make all the checks.

This. Sounds like you have a good doc!

[Deleted]

Not concerned. Sounds to me like the doctor just wants to double check and this will save your daughter a poke if any concerns were to come up.

FWIW, my daughter is also teeny. We just had her two-year appointment yesterday. She's 12th percentile for weight and smaller than some one-year-olds we know. But she is meeting all of her milestones and is really healthy. Someone has to be on the bottom of the growth chart!

[corgimom]

Aug 21, 2019 8:41:00 GMT -5 Ashley&Scott said:

Aug 21, 2019 8:38:27 GMT -5 Waffles said:

I wouldn't be concerned, and if anything I would be glad the doctor is being thorough/taking advantage of blood being drawn anyway to make all the checks.

This. Sounds like you have a good doc!

I really do like her! I am glad she's being thorough because I do ask at every appointment if she has any concerns about her size - she always says 'no' but it's nice to know what she isn't over looking anything! Her team is really great so I've been happy to have DD see her. Bonus! She was in 2 offices but they are moving completely over to the one that is closest to us so I don't have to make appointments for 2 days out of the week to save us a 20 minute drive!!

[corgimom]

Aug 21, 2019 8:41:07 GMT -5 @angryharpy said:

Not concerned. Sounds to me like the doctor just wants to double check and this will save your daughter a poke if any concerns were to come up.

FWIW, my daughter is also teeny. We just had her two-year appointment yesterday. She's 12th percentile for weight and smaller than some one-year-olds we know. But she is meeting all of her milestones and is really healthy. Someone has to be on the bottom of the growth chart!

Thanks for this - it's really great to hear! I always tell myself that to have a growth chart and have kids at 50% some kids have to be at 100 and some kids have to be on bottom! But again, that's logic and not emotion. I guess the advantage is that she wears clothes and the same size diaper for waaay longer, hah!

[joy]

Nope - I would not be. She’s small. They just want to make sure her thyroid is working properly. If it’s not, there’s an easy intervention for underactive.

[gigem]

I don’t think you need to be concerned per se but it is worth discussing with the pedi once you have results. Your dd is still very young to be concerned about growth hormone from my experience but all doctors are different. Ds1 will be 5 in a month and he is a bit less than the 5% curve for weight and height. He was not especially tiny at birth, it was about 1yr when he fell off the charts for weight and height and was about the size of your dd at that age. The pedi always made sure we came in regularly for appts (more often than the std well checks) so that we could have a good record of his growth. She encouraged us to feed him heavy calorie foods but he was/is a light eater. We have always gotten comments about his size, from the time he was about 2 he looked like a 12mo old (didn’t act like one obvs) but at that time the pedi said they didn’t really start testing hormones until school age.

So now that we are at that age he is under the care of a pedi endocrinologist and has been through growth hormone stimulation testing recently and just last week had an mri of the pituitary/hypothalamus region. We haven’t met with the endo after all that so not sure where we go from here but at the initial appt she asked a lot about his medical history of course, his eating habits, his development (one question eg was if he got teeth late). Then she made him a personalized growth curve which is based on his potential height: avg of me and dh plus 2in and she also did one for dd who is 6. From all this she showed us that he could never reach his potential avg height based on the curve he is on now which is 1.5std dev from his personalized average. 2std dev below is severe growth issues.

Anyways I am not saying this to scare you but my advice is to stay proactive with charting her growth so that if/when you might see an endo you’ll have lots of data. Do you have other children?

Finally I will add that ds1 has always been healthy and met the standard developmental milestones. He does well in school and hasn’t been bothered yet (that we can tell) by his size. We don’t like to make a thing about it since it doesn’t bother him. His first blood test was the stud full panel plus thyroid and liver function. From this we learned that his igf1 is very low so there are other concerns than just being short in height.

[CloudBee]

No concern. It sounds like it's a standard lab at that time for any child beneath a specific percentile.

DS has labs drawn all the time, and often something else random is included that I'm not specifically told of in advance.

IMO, the receptionist should have kept her mouth shut. I don't like at all that she voiced concern by stating that this additional doctor ordered lab was "strange".

[glitzy07]

I wouldn't be concerned but would just want to have a good conversation about it if the results came back abnormal.

Also, I was born with hypothyroid and have literally been on medication since I was 5 days old. Of all the things to be afflicted by, it's relatively low stress and easily controlled. Hope it's nothing and you don't have to worry about it, but if you do, it will be ok!

[raangoli]

I would not be. BB has always been small but has gained steadily on her own curve and that’s what the docs have always said. And as someone else mentioned, someone has to be at her bottom of the chart right?

We keep an eye on her weight and height at hike and I do make mention of it when we bring her in.

Also like a PP said she’s young to be considered to be seen by a pediatric endocrinologist but keeping good notes as she grows is always good idea in case down the road that’s something you will need to look into. I’m mostly saying that for myself as well 🙃

[achi]

Aug 21, 2019 9:04:19 GMT -5 CloudBee said:

IMO, the receptionist should have kept her mouth shut. I don't like at all that she voiced concern by stating that this additional doctor ordered lab was "strange".

This is where I'm at. Unless this receptionist has advanced medical training (which I doubt, seeing as she's working as a receptionist) it's not her place to determine whether or not a test that the doctor has ordered is "strange." I'm sorry this caused you unnecessary worry. 

It sounds to me like your doctor is being thorough and now is a good time to do the tests since your little one is getting bloodwork done already. Better to only subject her to one draw. 

My DS was quite small from the time he was 6 months until about the age of 2.5 when he "caught up" and was back at the ~50% mark. We were initially concerned but he kept on his own growth curve and was meeting developmental milestone. Our GP did refer us over to a pediatrician who ruled out anything that might have been concerning. He was just (and continues to be) really active and not an amazing eater. 

[corgimom]

We don't have other kiddos yet. For what it's worth, DH and I are pretty average in height & weight - we are both the same height at 5'6" so DH is shorter than average for a man, as are his brothers and dad.
We actually get a height and weight growth chart at each of her appointments to see where she is now and in comparison to previous visits. I print these out and keep a file of all her visits, so it's good to know these might come in handy! Hopefully we'll never need them, but I like to have all of our records easily available to us.

This visit is the closest she's ever been to the line for weight so I was pretty excited about that! The doctor said her BMI is at the 27th percentile and that she is very proportionate which is part of the reason she hasn't been concerned. Plus, this girl can eat!

[sillygoosegirl]

Not being concerned is not the same as not investigating. It's good that your pediatrician is looking to see if there is a reason your child is smaller than 99% of children her age. Someone has to be the smallest, but if it turns out there is an underlying health problem causing it, better to know than not know.

I've been dealing with health issues lately and it's easy to go down the rabbit hole of "I hope it's this, I hope it's not that, please don't let it be this other thing." But the fact is, whatever is going on in my body is what is going on in my body. The thing to really hope for is to understand as well as possible what is going on, so I can get the best possible treatment.

[corgimom]

I'm not really upset at the receptionist as she didn't say anything outright until I questioned it. I asked her what the blood work included and the last one was TSH. I asked what TSH was and she said "It's a thyroid test?" sort of like a confused question. So I asked if that was normal and she said it seemed strange for the 15 month blood work so she'd ask if it was meant to be included. She then confirmed with the nurses that the doctor included it because of her size, so that's when I emailed the doctor to see if she had any actual concerns my husband didn't accurately relay.
I also really like the front desk staff at this office so I guess I also don't want to be upset with them!

[corgimom]

Aug 21, 2019 9:26:35 GMT -5 sillygoosegirl said:

Not being concerned is not the same as not investigating. It's good that your pediatrician is looking to see if there is a reason your child is smaller than 99% of children her age. Someone has to be the smallest, but if it turns out there is an underlying health problem causing it, better to know than not know.

I've been dealing with health issues lately and it's easy to go down the rabbit hole of "I hope it's this, I hope it's not that, please don't let it be this other thing." But the fact is, whatever is going on in my body is what is going on in my body. The thing to really hope for is to understand as well as possible what is going on, so I can get the best possible treatment.

This is all so true and good for me to keep in mind, thank you!

I really hope it's nothing but it's always better to know. Overall she's been a healthy girl and always meets developmental milestones, so hopefully if there is something going on, it's minor and easy to treat.
Thanks to everyone that has shared their own experience or their kids experiences with their size or thyroid. It's good to hear that if there is something going on that is causing her to be small, that she'll be easily treated and still get to be the happy, active girl she is!

[goldengirlz]

Aug 21, 2019 8:09:10 GMT -5 ohgillian said:

I wouldn't be super concerned about the inclusion of the thyroid test - presumably her thyroid was normal on her newborn screening panel, and even if it turns out to be problematic now, typically that can be treated with medication.

However, at less than the first percentile, I'd personally ask the pediatrician if a consult with peds endocrinology is indicated. (And I'd want a good explanation of why it *isn't* indicated.) It's good that she's keeping steady with her own curve, but at the same time, I wouldn't want her to stay on that same curve into adulthood.

For some kids, the curve is what it is. My DD was also off-the-charts tiny as a toddler — 17 lbs at 1 year and 19 lbs at 2. We did the whole rigamarole: gastroenterology, endocrinology, even cardiology (because she had a heart murmur.) All was normal, even her growth hormone levels.

She’s still tiny and she’s likely going to stay on her curve into adulthood — whether I want her to or not. 🤷‍♀️ Some things are just genetics, not something that can be “fixed.”

[Ashley&Scott]

corgimom, that seems like an innocent conversation with the front desk. I wouldn't be upset with them either.

[mbcdefg]

My DD is 26 months and very small, and her pedi has always said she’s just “petite.” Her bloodwork always comes back normal. She’s heathy, doing well with milestones, and eats like a fricking horse, so we KOKO.

The comments on her size do get annoying, but we just reply with “her doctor says she’s fine” and move on.

[ohgillian]

Aug 21, 2019 9:30:51 GMT -5 goldengirlz said:

Aug 21, 2019 8:09:10 GMT -5 ohgillian said:

I wouldn't be super concerned about the inclusion of the thyroid test - presumably her thyroid was normal on her newborn screening panel, and even if it turns out to be problematic now, typically that can be treated with medication.

However, at less than the first percentile, I'd personally ask the pediatrician if a consult with peds endocrinology is indicated. (And I'd want a good explanation of why it *isn't* indicated.) It's good that she's keeping steady with her own curve, but at the same time, I wouldn't want her to stay on that same curve into adulthood.

For some kids, the curve is what it is. My DD was also off-the-charts tiny as a toddler — 17 lbs at 1 year and 19 lbs at 2. We did the whole rigamarole: gastroenterology, endocrinology, even cardiology (because she had a heart murmur.) All was normal, even her growth hormone levels.

She’s still tiny and she’s likely going to stay on her curve into adulthood — whether I want her to or not. 🤷‍♀️ Some things are just genetics, not something that can be “fixed.”

I understand that -- I could have been clearer in my response and I apologize if what I wrote seemed (was) insensitive. I was coming from the perspective of having a child who was underneath the curve for the first several months -- she grew, but very slowly -- and she turned out to have multiple medical problems that contributed to that. She's now about 25%. Of course if there's nothing medically wrong, then nothing can be done. I was trying to say that it's important to make sure there's nothing being missed.

[Deleted]

Aug 21, 2019 9:22:15 GMT -5 corgimom said:

We don't have other kiddos yet. For what it's worth, DH and I are pretty average in height & weight - we are both the same height at 5'6" so DH is shorter than average for a man, as are his brothers and dad.
We actually get a height and weight growth chart at each of her appointments to see where she is now and in comparison to previous visits. I print these out and keep a file of all her visits, so it's good to know these might come in handy! Hopefully we'll never need them, but I like to have all of our records easily available to us.

This visit is the closest she's ever been to the line for weight so I was pretty excited about that! The doctor said her BMI is at the 27th percentile and that she is very proportionate which is part of the reason she hasn't been concerned. Plus, this girl can eat!

H is moderately tall, and I'm moderately short. We're both obese. I gotta tell you, it's a mindfuck and a half to be a fat mom raising a girl on the bottom of the growth chart. But she's developing normally - fine motor, gross motor, language skills are all on track or even ahead of her peers. She doesn't eat a lot, but she isn't lethargic and shows no signs of a vitamin deficiency. She's just small. Her doc isn't concerned, so long as she stays on this curve and keeps developing. Sounds like your girl is similar. My guess is that if she weren't already getting blood taken, they wouldn't test, but why not make sure if she's already getting poked?

[aspentosh]

I, personally, would not be concerned but I'd want to know the results and the true reason for sending out for the test. If it's a benchmark thing (all kids less than 3%ile have the test) then you know it was a basic thing. If it's because of a concern, I'd want to know that.

FWIW, DD was about that size at 12 months and rode the 3-5% for most of her first two years. Sometimes she dipped to 1% for weight. I was stressed about her size but she was also sticking to a "line" and was hitting her developmental milestones. And yes, she loved to eat. At 7.5 she is still long and lean but active and healthy and not even the smallest in her class!

[pooh8402]

Aug 21, 2019 8:38:27 GMT -5 Waffles said:

I wouldn't be concerned, and if anything I would be glad the doctor is being thorough/taking advantage of blood being drawn anyway to make all the checks.

This is exactly my thought process as a parent, as a nurse and as a future provider. I will often draw an extra tube when I'm admitting/working up a patient in ED, just because I'm already poking them and the provider may add on an extra test.
. 
ETA: My sisters and I have always been small. My sisters were at the bottom of the growth curves. My youngest sister, when she was entering junior high, was probably 4 1/2 feet tall and I would be surprised if she topped 60 pounds. My mom took her to a new doctor for her athletic physical and he did a full workup. Nothing was wrong. My sister is just tiny and some people just are. She's now almost 29 and is 5'2" and about 90 pounds.

[kellikans]

DS is the exact same way. At his 15 month appointment he was just shy of 19 pounds and 28" tall. He was IUGR and has been 2nd percentile since he was born. He's tiny but he's been growing along his own curve, so his pedi hasn't been concerned. At his 15 month appointment he had bloodwork done, including thyroid and growth hormone (all came back normal), and we are actually going to see an endocrinologist next week just to make sure we aren't missing anything on why he hasn't started catching up on the curve (usually IUGR kiddos catch up by age 2). His pedi isn't concerned (we're more concerned than she is), but she wants to check all of the boxes.

So I wouldn't be too concerned about her ordering some extra labs. She probably just wants to get a full picture. It doesn't hurt, especially since she's having bloodwork done anyway.

[kellikans]

Aug 21, 2019 9:37:12 GMT -5 mbcdefg said:

My DD is 26 months and very small, and her pedi has always said she’s just “petite.” Her bloodwork always comes back normal. She’s heathy, doing well with milestones, and eats like a fricking horse, so we KOKO.

The comments on her size do get annoying, but we just reply with “her doctor says she’s fine” and move on.

Omg, yes! The comments on his small size all the time are so annoying!

[cabbagecabbage]

Yeah. As long as you have decent insurance and this won't be $$$ out of pocket, I'd consider it a very cautious test and be glad you'll have more info moving forward. Since she's already getting bloodwork, I'm sure the doctor thought it wouldn't hurt to double check thyroid function. I wouldn't be concerned at all.

And since people are touching on size, I have a petite 3yo son. He's not tiny but is slender and small and super healthy. Isn't it messed up that our culture thinks every baby should be in the 99th percentile for a couple years but then be nice and thin? Like, we have a Weight Watchers App for children and everyone brags their baby is off the charts or so tall but by grade school terrified their child could be chubby. What is the day in a kid's life it's no longer good to be chubby and now you get teased? Basically, I think people are ridiculous and our poor kids deserve better than the body issues we project onto them and this is my rant to the wind and not directed at anyone in particular.