A 6 year old boy is brought to the clinic by his mother because of concerns that he is shorter than other children his age. He is previously well. 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 with no dysmorphic features. Plotting his growth reveals the following: Height and weight have been following along the third 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: Normal.
Musculoskeletal examination: Unremarkable.
Skin examination: Unremarkable.

 

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