A 9 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 Dad is 5'9'', mom is 5'4'' and dad first shaved at age 17. On examination, he is well appearing, but looks younger than chronologic age. 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