Letter from Public Health Nursing to say they want further contact ref height/weight - worried... :-(

[Katnisscupcake]

DD is 4.4 and VERY small for her age, but then she always has been.

She's only 93cms high and weighs 14kilos.

But her red book shows that she's always been small and the centiles she's on have always fluctuated. She's been between 2nd-9th since she was 12 weeks old and has been anything from 25th centile down to 0.4th from about the same age.

She's also had 3 operations (two eye ops and gromets) and all her development checks and they've always just said that she's small. They haven't been concerned.

She appears to be quite bright (reading at Level 3 and doing very simple mathematics) and at school they've said that her gross motor skills are exceptional (handwriting, drawing etc) so there are no developmental issues in that regard, but every time I see a 'referral' for anything I just panic.

As a baby the weight/height thing used to stress me out soooo much that we only took her for the set developmental reviews (1 year, 2 year etc). They all said that she's fine, just small.

What will happen now, does anyone know? DH is 5ft 7 and I'm 5ft 8. But DH's Mum was only 5ft and his sister is 5ft 2. DD looks very much like DH's side of the family, will they take this into account? Or because they haven't seen the red book, once they say that she's always been small, will they just let it go?

[KissesBreakingWave]

Don't see why they shouldn't; short kid from a short family is no more unusual than my kids being nearer seven foot than not. Your daughter is going to have to resign herself to a life of people bumping into her because they think she's further away, though.

[Katnisscupcake]

My main worry is that I heard that they only review the child's height against the parents. But I am quite tall and DH is average... It's his family that are small.

But other features etc can jump generations so I don't know why height etc can't!

[headoverheels]

Of course height can jump a generation. I'm sure your DD is fine, but remember they're only trying to help and make sure nothing is wrong. Try to stop panicking, you seem to be thinking it's a 'them and us' situation but you should be on the same side! All of you have your DD's health in mind.

[Twighlightsparkle]

Don't worry, go with it , sure i twill be fine.

If its any consolation my 5.1 year old is 93cm and 12.8 kg.

Seriously if they are healthy its fine.

[Katnisscupcake]

Headoverheels, you are totally right. I definitely feel like it's 'them and us' because my experiences have led to feeling unsupported and almost 'told off'. I am keeping faith that HVs are not all like that.

Twilight, thank you, I will try not to worry.

[Bakingtins]

Don't worry. it will be an automatic thing to flag up a further contact for any child who is very short/tall, heavy/light. I'm sure the doctor will agree with the other HPs you've seen that she is fine. Nobody is out to cause trouble. They are just box ticking to make sure she has been checked. The letter is not telling you anything you didn't already know.
I have a DS 2 who is titchy, was off the bottom of the charts as a baby and now scraping along 2nd centile. He is healthy and happy and eats like a horse, and everyone is agreed he is fine. I'm sure I will get one of those letters when he is in YR and then you can tell me not to be daft and to stop worrying.

[ReallyTired]

If you don't want further contact with public health nurses then I suggest you ask for a referal to a paediatrian to reassure everyone. It would be criminal for health professionals to "let it go".

93cm is very short and its understandable that it is red flag to health professionals. I'm sorry your mother in law and sister in law are of normal height, but your daughter's growth is abnormal. Grommets are a minor op and should have no affect on growth. I would be surprised if eye ops stunt growth. I think a paediatrian would want to rule out hormone problems or see if there is any underlying condition causing the lack of growth.

If it was my daughter I would be demanding a referal to a paediatrian. (My daughter is the same age and is 96cm tall and weighs 15.4kg)

[Katnisscupcake]

ReallyTired, but as you can see just from this thread there is another child who is the same height as my daughter. She has two friends who are also the same size as her (at different schools). And surely if she is on the centiles at all it is not 'abnormal'.

Having read other comments that you've written on other threads, I do think that you could word your posts slightly differently.

[Bakingtins]

93cm is 0.4th centile for a 4.4yr old, so whilst it is at the short end of the spectrum it is still on the charts and 1 in 200 perfectly normal children will be this height. If she has always followed the low centiles but is following a normal growth curve then there is unlikely to be a problem, as all the HPs who have seen her so far have agreed. reallytired I don't think your comments are helpful. If she continues to follow the 0.4th line then she will have an adult height just over 5 feet, which is similar to the women on her dad's side of the family.

[Katnisscupcake]

Bakingtins, exactly and thank you! We've looked through our immediate family and the height seems to follow that of the paternal line (in DH's family...) and if that continues with DD, she will be around 5ft as the females (and males actually) on DH's side are small. My FIL is only 5ft 5 and my MIL was 5ft.

[gymboywalton]

i am sure it is just being short but is better to get it checked isn't it?

what would wory me is that she has moved between the .4th centile and the 25th
that's a big jump

[Sidge]

Don't panic, it's just triggered an indicator for review by the School Health nursing team.

I used to be a school nurse and we reviewed all children whose height/weight fell outside certain parameters. Remember they have no access to previous health records, they can only go on the measurements taken in Reception screening.

Not all families will have been in contact with other health professionals, so screening is just an opportunity for catching those children that might need referral to a paediatric growth clinic for example. Just like those with unusual hearing/sight results will be referred for audiology or optometric testing.

Your daughter is small so I imagine they'll just ask if they can monitor her growth over the next year or two. If they see she is growing normally they'll be happy.

[3bunnies]

One of my dd is v small - similar height to yours at that age. She has grown a little recently and finally passed on most of her 3yr old clothes (she's nearly 7), she has grown a bit more recently but I think she will always be little. She is only just over 16kg and about 104cm. She has been monitored by dietitian (for other reasons) and they are not unduly concerned. It is useful to check it out but don't be surprised if it comes to nothing. We refused the school measuring as she had been measured so much in her little life and detested it. She didn't want to be measured again. We just monitor at home and yearly dietician checks.

[Jenny70]

They will just want to check she is eating right and absorbing the food she eats. Conditions like coeliac and metabolic disorders may mean good nutients go in, but body can't absorb them. Some fussy eaters will also show poor growth, and our paed said too much milk can reduce appetite and thus cause growth probs.

My son had check, came back small but healthy.

It is not about you, but a check that all is fine with your child. When that tragic case of the boy that died was in the media, everyone was full of why wasn't his tiny size picked up... well if it means all small children are given a quick once over and check their health is fine, that's great, in my opinion.

[Belmo]

It probably is just her normal height, but I'd want a check up.
My youngest brother was on the 2nd centile (between 9th and 2nd from birth) and at six my mum demanded a check up although health visitors weren't interested. Turned out he was producing almost no growth hormone and has had a daily injection ever since.
He's almost 16 now and 5 foot 6, without the injections he would have been more like 5"2. I think it is seen as a bigger deal for men to be short than women but growth hormone also plays a really important role in puberty, fertility and bone density I think.
Obviously it's far more likely that she's naturally small but I really would get it checked out to be on the safe side.

[kilmuir]

5ft 7 sounds shrt for a man, not average

[Katnisscupcake]

gym, you're right, although I probably should mention that the drop happened before she was 12 months old and since then she has carried on along the lower centiles, along with her weight...

I'm sure they will decide once we see them what they want to do. I don't know how quickly it will be though...

[Katnisscupcake]

I think I just want to reduce the stress for her. She's been through so much.

I'm probably a bit raw because we'd literally just got back from the hospital, when I got the letter, where she'd had an operation on her eye. It's her 3rd operation and I don't want to keep pulling her out of school and I really don't want anymore needles being stuck in her for blood-tests. Poor little mite. The op was horrid because they couldn't get the cannulas in her hands so the thought of sticking more needles in her makes me feel sick .

[Katnisscupcake]

Really Kilmuir? I won't tell DH that... He likes to add the extra half an inch on now and again and hates it when I wear heels...

[missmapp]

ds2 is now6, 99cm and on the 0.2 percentile for height and weight. We go to a growth clinic, but at every review they say
'He is still following his percentile , lets review in 12 mths'

He has Noonans syndrome which predisposes you to short stature- they have special charts for this condition and on those he is the 25th percentile!!

Go to the review, but you know your child and you know he is healthy!
( the only problems we have is when he cant go on rides in LEGOLAND/Thorpe park due to his height- he is desperate to get over 1m!!)

[TenthMuse]

Just to add my own reassurance to what others have said - I was very small for my age and remember a similar thing happening to me when I was eight or nine following a routine school height/weight check. My parents received a letter and we went along to the review, where they did some basic checks to confirm there weren't any underlying causes (coeliac etc) and that I was absorbing nutrients ok.

I think they did raise the possibility of giving growth hormone injections, but my parents weren't comfortable with this (they're both small themselves, so it's entirely genetic) and the doctors didn't push the issue at all. I ended up having a bit of a growth spurt a year or so later and am now 5 foot 3 - not exactly huge, but completely within the normal range. Once again, it will be an automatic referral based on the limited information they have. I'd want to get DD checked out just to be sure, but in all probability it'll be absolutely fine. Don't worry - they're just doing their job!

[Katnisscupcake]

Thank you all soooo much. You have massively reassured me and if they have to do checks, then I will go with it.

TenthMuse, like your parents I really don't think I would be comfortable with growth hormone injections (someone mentioned that their sibling had them daily!!), I wouldn't want to subject her to that.

But, in all honesty, and sorry if this is really personal, do you wish your parents had?? I am 5ft 8 and I've always hated being tall. My DBro's GF is 5ft 1 and doesn't like being small. I guess we're never happy...

DD has an eye problem. The muscle in her eyelid was damaged during ventouse delivery and has never worked. So she's had to have two operations to hold her eyelid open. She's endured so much and will continue to as she grows because the eyelid will never work properly. But from now the choice to have an operation will be up to her, how she feels about her eye.

I guess if it does turn out that there's a problem with her growth, maybe the choice can be down to her... She always talks about her friends being taller than her so it may be something she'll choose if it comes to that...

Does anyone else think 'why my baby?' I feel so guilty that it's something we've done...

[QueenofLouisiana]

If it help at all, DS always triggers a dental review letter. He has an overbite which cannot be corrected yet. We know that, his dentist knows that, the specialist orthodontist knows that. But still we get the letter, which I always follow up- just to say I've done it.

Better to follow it up and prove there's nothing wrong IMO.

[RandomMess]

Seems absolute common sense to me that she's just going to be petite like you DH's family. I've seen it in plenty of other families.

I'm short from a short family, DH is tall from a tall family. Our dds seem to be following the following pattern
#1 exceptionally tall 95th tall -waif like
#2 short 20th centile - average
#3 50th centile - waif like

Try to chill, they are just like out for those most non-average.