A 11 year old boy is brought to the clinic by his mother because of concerns that he is shorter than other children his age. He has a history of occasional constipation. Family history reveals that both parents are of average height and the 15 year old sister just had her first period. On examination, he is well appearing, but looks younger than chronologic age. Plotting his growth reveals the following: All growth parameters are at the fifth percentile.

Respiratory examination: Normal. 
Cardiovascular examination:Normal. 
Abdominal examination: Soft and nondistended.
Musculoskeletal examination: Unremarkable.
Skin examination: Unremarkable.

 

What is(are) the most important initial investigation(s)?

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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