A small child does not necessarily become a small adult-Ask Dr. Paul Library

DEAR DR.PAUL: My 11-year-old son, is the smallest in the class and the shortest on his baseball team. He is teased by his classmates all the time. What can I tell him? Will he always be small or will his growth catch up to his peers?

PEDIATRICIAN DR.PAUL Answers: As you know, no two children are alike. Each child grows and develops at his or her own pace. Your son is a pre-teen, and I would imagine that in his class the other children are all starting to grow and experience pubertal changes. Girls are a bit ahead in this category because they tend to go into puberty earlier than boys.

When I evaluate a boy such as yours, the first thing I want to see is the growth curve. If the curve shows that the child is following a steady growth rate - albeit lower than average - this is reassuring.

Looking at pubertal changes is also important, and in cases such as your son's puberty has not begun yet. Finally, given that there are no other medical problems (and there usually are none), we have to look at the family history. How tall are the parents? On average, the height a child will reach is somewhere between the mother's and the father's.

Is there a history of small-sized people in the family? And importantly, what pattern did the father show during his pre-teen and teen years? It's important to make a distinction as to the cause of the small size: is it a family trait or a constitutional growth delay? I would like to spend some time on this latter condition, as we see it quite frequently in boys in situations similar to your son's.

Boys with constitutional growth delay typically lag behind their classmates and friends in growth rate, size and onset of sexual characteristic (pubertal) development. However, at one point, usually in the mid-teen years, puberty begins, and they grow and catch up to become as tall, or taller, than their peers. In most cases the father will have had experienced the same pattern during his adolescence.

How does one confirm or identify constitutional growth delay? The family history and pattern of growth of both the father and child are important clues. In general, this is enough to convince us. However a simple X-ray of the wrist can help. It is interesting to know that there is such a thing as "bone age", which reflects the state of growth of a person's body. The X-ray is compared to standard reference X-rays and a bone age is assigned. For example, a normal 20-year old person will have a bone age of a 20-year-old. In constitutional growth delay, a 12-year-old boy might have a bone age of a 10-year old boy. This delay in bone age tells us that the child is behind in growth and that there will be a catch up.

Knowing this will, of course, reassure the parents, but most importantly this information is reassuring to the child and will likely be a boost to his self-esteem.

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