A 11 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 an unremarkable past medical history. Family history reveals that both parents are of average height and mom's menarche was at age 14. On examination, he is well appearing with no dysmorphic features. Plotting his growth reveals the following: All growth parameters are at the fifth percentile.

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 with no organomegaly.
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