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[quote=Anonymous][quote=Anonymous][quote=Anonymous]Has she always been this small or was she previously following a different curve on her growth charts?

If her bone age is 3 years delayed she should essentially be the same size as the average 8 year old. However, the BMI is still problematic.[/quote]

[b]Bone age and size are not really related.[/b]  It means that [b]the spaces between the bones in her wrist, that should close as she matures, are the same size [/b]as a younger child, not that her bones themselves are the same size.

It can be a sign of a problem, but isn't necessarily a problem.

I'll also say that while I wouldn't jump to a feeding tube on the suggestion of just one professional, a feeding tube was super helpful for my child, and far less challenging than I imagined.  He wasn't a tween, and the reason he had it was different, so maybe take that with a grain of salt, but it really one of the best things we did.[/quote]

No. Bone age has nothing to do with "the spaces between the bones." It is about assessing the level of ossification and calcification at the growth plates.

[quote]The level of skeletal maturity can essentially be determined based on two characteristics: The level of growth in areas undergoing the ossification and the level of calcium accumulation in those areas. From infancy to adulthood, these two characteristics follow a certain and specific pattern and timeline.

Hand X-ray in pediatric endocrinology: Skeletal age assessment and beyond
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4266871/[/quote]

Yes, bone age does correlate with bone size. This is because the long bones continue to grow until the growth plates have ossified and calcified secondary to the hormonal changes of growing through puberty. A young-for-age bone age indicates "constitutional growth delay," a common cause of (temporary) short stature in children. The short stature relative to others in the age group starts to resolve as they continue to grow after their peers' bones have matured and stopped growth at the growth plates.

[quote]Children with constitutional growth delay (CGD), the most common cause of short stature and pubertal delay,  typically have retarded linear growth within the first 3 years of life. 
...
At the expected time of puberty, the height of children with constitutional growth delay begins to drift further from the growth curve because of delay in the onset of the pubertal growth spurt. Catch-up growth, onset of puberty, and pubertal growth spurt occur later than average, resulting in normal adult stature and sexual development.
...
A radiographic study of the left hand and wrist to assess skeletal maturation is critical in diagnosing constitutional growth delay. Typically, the bone age begins to lag behind chronologic age during early childhood and is delayed in adolescence by an average of 2-4 years. Because the timing of puberty, the pubertal growth spurt, and epiphyseal fusion are dependent on biologic age (skeletal maturation) rather than chronologic age, all of these events are delayed in accordance with bone age.

https://emedicine.medscape.com/article/919677-overview[/quote]
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