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Doctor Visits
“We’re about to go see a doctor about my child’s growth.”
What should I expect?
If you are concerned about your child’s growth, the first step is to see his/her pediatrician. Concerns about growth can be addressed at a regular well-child visit, or you can set up a special appointment just for the purpose of discussing your child’s growth.
You should ask your pediatrician or family doctor:
  • About your child’s current height
  • About how your child has been growing since infancy
  • For copies of your child’s growth records
  • For a referral to a pediatric endocrinologist if appropriate (a children’s doctor who specializes in problems with growth, puberty, diabetes or other disorders related to hormones and the glands that produce them)
What to expect at your first visit to the pediatric endocrinologist:
A pediatric endocrinologist will generally perform the following procedures during your child’s initial evaluation (note this visit may take a bit of time):
  • Your child will be measured, and that measurement compared to those of other children of the same age/sex, and to earlier measurements of your child (if available)
  • Both parents (if available) will be measured, and height plotted. If one or both parents are unavailable, an estimated height may be used; however, estimated heights are frequently incorrect and are not a good guide to predicting a projected height for a child
  • The pediatric endocrinologist will ask a series of questions in order to obtain a detailed medical history, including questions about
  • Your child’s growth history
  • Any current or past health issues with your child
  • Parent’s/other relative’s growth histories
  • Parent’s/other relative’s health histories, to determine if any relevant medical conditions run in your family
  • The pediatric endocrinologist will examine your child
It is important to keep in mind that the diagnosis of growth disorders can be difficult, and multiple visits/doctors may be involved. If a growth disorder is suspected, some or all of the following tests may be performed depending on the clinical examination and past medical history of your child:
  • Blood tests
  • To look for chromosomal abnormalities
  • To rule out underlying diseases that may be associated with your child’s growth
  • To look for hormonal abnormalities, such as low thyroid or IGF-1 levels
  • A growth hormone stimulation test, as detailed below (this may also be called a “stim test” or an “arginine test”), may be performed to measure the ability of the pituitary gland to secrete growth hormone. The pituitary gland sits at the base of the brain and makes growth hormone
  • X-rays, to determine your child’s bone age, or the maturity/growth potential of his/her bones
  • An ultrasound (girls only), to look at uterine development and assess how close your child is to puberty
  • An MRI and/or CT scan of the brain, to rule out any structural abnormalities
A general explanation of what to expect with these tests is provided below.
Phase I Testing (these tests are generally done first)
Test Pre-test instructions Testing Results

Blood tests for:

—Chromosomal abnormalities

—Underlying disease states

—Thyroid abnormalities

—Insulin-like growth factor-1 (IGF-1) deficiency

Generally no fasting is required

A simple blood draw from the arm is performed to obtain a sample for testing

Usually available within a few weeks

X-rays

None

A special type of camera is used to take pictures of your child’s hand and wrist. This procedure does not hurt. Your child will have to hold still while the pictures are being taken, and will wear a special protective apron to ensure the rest of his/her body is not exposed to the X-rays

Usually available within a couple of days

Ultrasound

None

A machine is used to get an image of your child’s abdomen via high-frequency sound waves. This procedure does not hurt

Usually available within a few days
Phase II Testing (occurs when no abnormalities are found in Phase I)

Test

Pre-test instructions

Testing

Results

Growth hormone stimulation test

No eating or drinking (except water) after midnight the day before the test; no strenuous exercise the morning of the test

A small tube, called an IV, is inserted into the arm and a baseline blood sample is drawn. A drug (or exercise procedure) is then given to stimulate the release of growth hormone. Blood samples are then drawn for a period of 1 to 3 hours. The type of drug given, length of the test, and number of samples vary, and will be determined by your child’s physician. Symptoms may occur depending on which drug your child’s physician uses.  Ask your physician for an explanation of possible side effects

Usually available within a couple of weeks

Magnetic Resonance Imaging (MRI)

None

A magnet, radio waves, and a computer are used to produce pictures of your child’s brain. This procedure does not hurt. Your child will have to hold still for this procedure.  Younger children may require a sedative.  If you are concerned, you should discuss this option with your physician

Usually available within a few days

  

Brain Computerized Tomography (CT) scan

None

X-rays and a computer are used to produce pictures of your child’s brain. This test does not hurt. Your child will have to hold still for approximately 1 hour

Usually available within a few days
How should I prepare for the visit?
It may be helpful for you to bring the following information to your initial pediatrician/pediatric endocrinologist visits (note you may also want to ask the office staff if they have a list of information they would like you to bring):
What questions should I ask?
When visiting your child’s pediatrician or pediatric endocrinologist, it’s always a good idea to come prepared with any questions you may have. Worksheet E: Questions to Ask Regarding Your Child’s Growth (PDF) has a few to get you started, as well as space to add your own. Make sure you ask whatever questions you need to so that you have a clear idea of the plan for your child moving forward.
What information should I keep track of?
The more information you can keep track of in terms of how your child’s growth is being evaluated, the better. Worksheet F: Growth-related Doctor’s Visits (PDF) will help you to document this information.
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