hand study revealed bone age two years younger than actual age - concern?

[Anonymous]

So - ds is a picky eater, minor sensory issues, ADD - I could go on. Taking him to an OT in a little over a week. I've been told sensory issues "are just part of the package with ADD", but I'm so tired of trying to get him to eat - and his handwriting is laborious, and tending a little preservative these days.

So he's 9, and less than 50 pounds. We did a hand study (x-ray of his wrist to show bone age) - given his small size and the fact that, although he lost the teeth (naturally) on either side of his two front teeth a year and a half ago, permanent ones haven't come in. Hand study shows bone age of a 7 year old.

Which isn't so bad, right? It just means he will hit puberty later and stop growing later - ? Ped plans to monitor at ADD med checkups. Has anyone else experienced something similar? Advice?

[Anonymous]

My son has the same thing. I don't think it's any particular concern except what you said - puberty will occur about 2 years later than the average kid.

[Anonymous]

It's pretty typical. That whole picture could have described me, or my son, or his friend. We all have the "inattentive ADD package", as you say.

What are you worried about, exactly? That he won't reach his growth potential, determined in part by his genes?
I put heavy cream in DS's milk, pour olive oil on everything, add protein at every meal. I did the same when he was a toddler, nearing failure to thrive and taking 2 solid hours to eat one tiny meal (I am not exaggerating). Since his ADHD meds suppress his appetite, I load him up at breakfast and dinner, when the meds haven't kicked in or they've worn off, respectively.

Your son is old enough to type. After years of handwriting practice which led nowhere, I had to pick my battles with DS. He has the typing accommodation at school.

What sport is he doing? Usually these kids don't do well with team sports, but can do very well in individuals. Mine does ballet and swimming, and previously did gym. It is crucial for their coordination, flexibility and strength. he could try rock-climbing, which would strengthen his fingers and wrists. Perhaps piano as well, a gentler exercise for all the above.

[Anonymous]

Yes, that's what our doctor said about my super tiny, ADHD kiddo. He's 11 and only ways 54 pounds.

He'll likely never be super tall, but will grow slowly and continue to grow for a longer length of time than other boys that hit puberty earlier.

[Anonymous]

yes - his not so great diet - and the fact that his teeth aren't coming in - have me a bit worried. I didn't realize it until someone asked if he had lost teeth recently - too many other things to worry about! ADD meds curb his appetite when he's on them - but when off them, he's too distracted to eat.

He has a language disorder as well - so his communication skills aren't the sharpest. Combine that with his size and gentle disposition, and I worry about him being picked on. It has happened a bit, but fortunately, not to any great degree.

thanks for the assurances - ! Someone thought he was in K, rather than 3rd grade, earlier this year.

[Anonymous]

It would be worth a consult with a pediatric endocrinologist. It's the teeth that make me suggest it... My son has a growth hormone deficiency. He didn't have a delay with teeth, but many kids with GHD do. He had a lot of GI & feeding issues that they used to explain the slow growth - & they said the delayed bone age was good, but we finally saw an endocrinologist to rule out a deficiency & - lo & behold - he had a clear deficiency after testing - not even a maybe - it was definite. He's on treatment & his growth has taken off & his appetite has increased. He has ADHD too, so his weight is still low - he burns calories like mad, but I at least know that he is eating well.

[Anonymous]

Many special needs children appear younger than their age, OP. In the book "Far from the Tree," the author discusses the phenomenon of what he calls "babyfacedness," -- nature's way of making its most vulnerable populations appear the most appealing to their caretakers. I know my SN child still has the facial appearance of a toddler and she's nearly 10.

[Anonymous]

Anonymous wrote:It would be worth a consult with a pediatric endocrinologist. It's the teeth that make me suggest it... My son has a growth hormone deficiency. He didn't have a delay with teeth, but many kids with GHD do. He had a lot of GI & feeding issues that they used to explain the slow growth - & they said the delayed bone age was good, but we finally saw an endocrinologist to rule out a deficiency & - lo & behold - he had a clear deficiency after testing - not even a maybe - it was definite. He's on treatment & his growth has taken off & his appetite has increased. He has ADHD too, so his weight is still low - he burns calories like mad, but I at least know that he is eating well.

thanks! yes, all of this can certainly co-exist in a kiddo. The teeth not coming in is what really baffles me, since they fell out on their own. Did you like your ped endocrinologist/would you recommend? Who was it?

[Anonymous]

We did a bone age with an endocrinologist for our DS when he was 13. His bone age was 1 1/2 years behind his actual age and the doctor said not to worry about it. He had a huge growth spurt a year later and is exactly where he should be in relation to the size of his parents. DS has been on ADHD meds since 1st grade and quite honestly from everything I have read recently, those meds have minimal impact on a child's final height. At this point from what I've seen with my own DS I'm fairly convinced this is accurate.

[Anonymous]

My younger DD was like this until age 7 when we had her appropriately tested for food allergies. She has caught up in growth. Still ADHD.

[Anonymous]

We saw a GI for a round of testing for other things and found completely a very significant Vitamin D delay and some other totally unexpected GI findings. Have you considered seeing one?

[Anonymous]

We were told that having a younger bone age is a good thing. They look to see if the growth plates are closed or closing yet because this suggests that your child is almost done growing and whatever height they have achieved is likely to be their permanent adult height.

When our daughter was 13 and had no signs of incipient puberty and was wearing a size 8 in children's clothing, they did the hand study and we were all relieved to find that she still had several years worth of growing to do. She was in the fifth percentile for height and weight and we were wondering about growth hormone. They told us that she was nowhere near done growing and was clearly delayed (as both my husband and I had been). She got her period when she was sixteen, grew eight inches between the age of 13 and 16 and is now taller than her sister. The growth plate study is meant to be reassuring and for us it was.

[Anonymous]

Who does the growth plate study? Does anyone have any recommendations?

[Anonymous]

Anonymous wrote:It would be worth a consult with a pediatric endocrinologist. It's the teeth that make me suggest it... My son has a growth hormone deficiency. He didn't have a delay with teeth, but many kids with GHD do. He had a lot of GI & feeding issues that they used to explain the slow growth - & they said the delayed bone age was good, but we finally saw an endocrinologist to rule out a deficiency & - lo & behold - he had a clear deficiency after testing - not even a maybe - it was definite. He's on treatment & his growth has taken off & his appetite has increased. He has ADHD too, so his weight is still low - he burns calories like mad, but I at least know that he is eating well.

What does his treatment look like?

[Anonymous]

Anonymous wrote:We were told that having a younger bone age is a good thing. They look to see if the growth plates are closed or closing yet because this suggests that your child is almost done growing and whatever height they have achieved is likely to be their permanent adult height.

When our daughter was 13 and had no signs of incipient puberty and was wearing a size 8 in children's clothing, they did the hand study and we were all relieved to find that she still had several years worth of growing to do. She was in the fifth percentile for height and weight and we were wondering about growth hormone. They told us that she was nowhere near done growing and was clearly delayed (as both my husband and I had been). She got her period when she was sixteen, grew eight inches between the age of 13 and 16 and is now taller than her sister. The growth plate study is meant to be reassuring and for us it was.

I believe we're on a similar trajectory with our DD. She's in 5th grade and over the last year the pediatrician noted 'decreased growth velocity'. She had dropped from the 25th percentile to below the 5th. Yet, the bones in her hand indicated she had a lot of growth potential. Based on the hand study, they estimate she'll be taller than me but probably not quite 'average'. She's my NT kid.

I have a younger SN kid who lost the teeth on either side of his front teeth in 1st grade. They still hadn't come in by 3rd grade so we had the dentist look at them on X-ray. They were present but just hadn't descended. They didn't come in until the middle of 4th grade.