A 14 year old boy is brought to the clinic by his father because of concerns that he is shorter than other children his age. He has a history of wheezing with viral illnessess as a toddler. Family history reveals that both parents are of average height and mom's menarche was at age 14. On examination, he is well appearing. Plotting his growth reveals the following: Height and weight have been at the 10th percentile since infancy.

Respiratory examination: Normal. 
Cardiovascular examination:There is a grade 2/6 systolic ejection murmur at the left lower sternal border that is best heard when the child is supine. 
Abdominal examination: Soft and nondistended.
Musculoskeletal examination: Unremarkable.
Skin examination: Normal.

 

What is/are the most appropriate initial step(s) in management? Check all that apply.

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Authors

Dr. Joanna Holland

joanna.holland@iwk.nshealth.ca

Dr. Karen Forbes

Reviewers

Dr. Mumtaz Virjii

mvirji2@cw.bc.ca

Dr. Theresa Wu

theresa.wu@ahs.ca