## My son is the smallest in his class

The question

My 10-year-old is the smallest in his class by several inches. I know puberty is to come, and otherwise he is completely healthy. Should I be concerned about what I perceive as slow growth?

One of the most important questions to ask is if he has always been short. If his height has always been in the same percentile, then at least he is consistent. It's a good idea to compare your son to himself, and not to his peers. My advice would be to check both his weight and height every six to nine months and to make sure it stays consistent.

The next step is to factor in the mom and dad's heights. There is a formula you can use to calculate the maximum and minimum predicted height.

For boys, the lower limit in inches would be: (Mother's height in inches+ Father's height in inches) divided by 2; then subtract 1.5 inches. The upper limit is (M +F) divided by 2; then add 6.5 inches.

You mentioned that puberty has not yet started. One way to tell if he has growth potential that will show up once puberty kicks in is to get an X-ray of his wrist. This is called a bone age. If his bone age is delayed and younger than his actual age, he still has much potential for growth.

It's reassuring that he's otherwise completely healthy and makes it less likely that he is small due to any disease.

The use of growth hormone injections is quite uncommon. In Canada only endocrinologist can supervise this. It's very expensive and most experts agree that the cost may not be worth it.

The bottom line: Most shorter kids are short because of genetic reasons and they are not at a disadvantage socially or economically later in life.