Celiac, hypothyroid, EE, growth hormone deficient? Are those thought to be related somehow? I suppose Celiac and some kinds of hypothyroid could go together.... or the hypothyroid and GH deficiency is she has a pituitary disorder (though that wouldn't connect with Celiac.) If she has low-functioning pituitary overall, that could include something called "diabetes insipidus". which you can screen for with urine and blood tests. I imagine she's been tested for this. The ped endo would be the person best equipped to look for diabetes insipidus or pituitary problems.
I have no particular concerns about a four year old girl wearing pullups at night. And even the day accidents at four aren't that uncommon. It's all of these complex other issues that make me wonder if they're connected somehow. I'd guess that it's still likely that the dysfunctional habits discussed above are the cause, but with all that other stuff going on I would hesitate to diagnose those that without more information.View Thread
There are a wide variety of things that can cause short stature in kids.
The first to look for is to always compare the child to the parents—parents who are short are going to have shorter kids. In your case, it sounds like your daughter is predicted to be much shorter than expected, so further evaluation is needed.
Many children also seem short because they're having a delay in maturation. Basically these kids are going to be "late bloomers"—they will grow, but they'll have their growth spurt later. A bone age xray and careful tracking of height over time can lead to this diagnosis. However, you mentioned the predicted adult height of 4'7"—so in this case, it is more than this kind of constitutional delay.
Common general medical problems that can cause short stature include celiac disease and thyroid disease, along with less-common things like Crohn disease and several others. I'm assuming that she's had a thorough medical evaluation, and these conditions have been ruled out.
Babies who are born small for gestational age usually catch up, but some may have persistent small size for reasons that aren't entirely clear.
Growth hormone deficiency (or, even more rarely, resistance to growth hormone) can cause short stature. It can be difficult to test for this reliably—a single blood draw may not show this. Often, a "provoked" test is needed, where medicine is given by IV to drive up the growth hormone levels, which are then tested. Even this kind of testing may not pick it up 100% of the time.
In girls, a genetic condition called "Turner Syndrome" causes short stature. That's a chromosome test, or (better) a test called a "FISH" probe for the x chromosome. Girls with Turner Syndrome have only one X chromosome instead of two. A change in the SHOX gene on the X chromosome (or a missing SHOX gene) can also cause shortness.
For all of these conditions I've listed in the last 3 paragraphs—SGA babies, children with GH deficiency, or girls with Turner or SHOX gene conditions—the treatment that can be offered is the same: injections of growth hormone. That is also FDA approved for children who are aiming to be very short as adults, even if the exact cause isn't known (that's called idiopathic short stature, and it sounds like that may be what your daughter has.)
These injections of growth hormones aren't easy. They're given every day, and they're very expensive. Also, they may help increase adult height, but only modestly—maybe by 1-3 inches, even after years of injections. So for a thriving, healthy girl, it may or may not be worth it to do this. That's up to you and your doctors to discuss. You will also have to consider how many years of growth she has left, and to maximize the potential effect of the growth hormone injections, you may have to delay her puberty.
You ought to be working with a pediatric endocrinologist, that's the best specialist to make sure that a thorough eval has been done, and that's the person to guide you through the pros and cons of growth hormone therapy if indicated.
Those school markers are usually non-toxic and harmless.
If you ever have concern about a toxic exposure, poisoning, or accidental ingestion of any kind, call the national poison control center immediately for advice: 1-800-222-1222.
I don't think posting on a board like this while deciding whether to take your child to an emergency room is the best way to help make a decision. Call your doctor, or call poison control-- don't wait to see if anyone answers a bulletin board post.View Thread
This may be entirely normal. Kids copy behaviors and are very interested in things they see, and it is natural to have some sense of sexuality even at this age.
However, there are some red flags to look out for-- if he's quite preoccupied or difficult to distract from these things, or if he's involved with play with children of different ages from his own, or if there is any coersion, those situations need further evaluation.
Also, it may be that he is being exposed to material that's too mature for him-- almost any network TV includes material that can be quite explicit. Or, he may have been watching what adults in his home are up to. This is an age where he is naturally curious, and it is reasonable to limit his exposure to what he can understand and what's appropriate.View Thread
Doc, does my child really need to take that antibiotic?
Knowing when to ask that simple question can help keep your child safe and healthy. Some of this site is geared towards providers, but there's great info here to help parents too, especially under the "for everyone" link.View Thread
That is an unlucky amount of ick, even for a toddler. Where's he getting exposed to all of this?
A typical RSV infection does last a few weeks, with continued cough and misery. I'm not that surprised that he's still not well after that, especially considering he probably wasn't in great shape heading into that infection.
Still, it's been long enough that he certainly should be re-evaluated at the pediatrician.
Pediatric neurology is a very under-served specialty. I believe some states don't have even a single ped neurologist, and many big cities have a bare handful. Access to their services is very poor. We can talk perhaps some other time about why that is the case, but there isn't much you or your pediatrician can do about it. Specialists cannot magically make more time to see more kids. Believe me, they are already very, very busy.
Having had a second seizure in a relatively short time, it may be a good idea to start a medicine to prevent seizures, even before seeing the ped neuro. Your pediatrician may be able to make a friendly phone call to the neurologist for direction if he or she isn't comfortable doing this on his own.
I do not think it is likely that the lack of sleep is contributing to this in any way. Your pediatrician ought to be able to help you with strategies to help sleep habits.
I agree, you ought to be in touch with the surgeon and your pediatrician. This isn't a normal, expected complication of surgery, and this is way out of proportion of what to expect with narcotic pain relievers.
BTW, I'm not familiar with the term "septic surgery." What is that?View Thread