Pediatric endocrinologist?

[crazymama30]

So difficult child saw his pediatrician today, first well child check he has had with this guy as he is new since difficult child came home from Residential Treatment Center (RTC).

difficult child has always been small. He is 14, and the size of a fourth grader. He weighs 91lbs and is about 54inches tall. doctor is concerned as he is so small, and wants him to see an endocrinologist. Problem is? They have to look at things he does not want people to look at, if you get my drift. He refused to let pediatrician look today.

How important is this? I am not tall, ex is not tall and he was a very late bloomer. difficult child will fight this tooth and nail, and I don't know if he will cooperate or not. I have to travel 4hrs to see this doctor, and don't want to go if the exam cannot even be done due to difficult child's refusal.

difficult child has been on stims since he was 8. I think that the stims are part to blame for this. I am thinking that it might be wiser to take him off the stims first for a few weeks, more if I can stand it, and see how he does.

Opinions? I want to do what is right for difficult child, and know that what is right may not be what he wants.

 

[Liahona]

Just my opinion, I'd try taking him off stims first. And if that doesn't work to get difficult child on board with this. difficult child 1 also doesn't let anyone close to those areas, and thats not something I would force. But others might have different opinions.

 

[buddy]

This is where we were last year too. Yes they peeked just because they wanted to see if any signs of puberty had started but nothing like a physical or anything.

Anyway the more important part was the hand xray and lab work. Ps under arm hair can give a clue and if you've seen at all you can give an idea if there are any signs. doctor. actually said it didn't look like what they see with problems related to the stims and more like he was a later bloomer and so last Aug we were 14 at 86 lbs and way under the curve for height and now he is 15 and well in the avg range. Still lower avg for height at 5 ft. 2 in. but weight higher avg. @ 131 (problem more now shoes seem small again) and yea the rest grew fine too. Causes some sensory issues for him though ...like we needed more of that LOL. The endo was right. Said he would likely take off and he did. At the time we went he barely had started any secondary changes. He eats well. Stims never affected that with him. They did check things inc vitamin levels etc. And. Q was super low in vit.D. all else was great. but the idea of adding growth medications was not cool anyway. Enough complications in our life..

Glad we went but I'd call ahead and clue them in that if he doesn't cooperate with that part not to push it. Just a thought. Like you I was not super worried I knew his bio parents were not tall and I didn't much mind his growing slowly due to the aggressive issues. Wish he'd slow down now.

 

[DammitJanet]

I am of the mind that given what you have said that I would go. He is very small for his age even though both parents are small. Boys take being small very hard. The last thing you need is him getting bullied for one more thing. Just start preparing him at home that the doctor may have to check down there and it is no big deal. They wont hurt him, wont abuse him, wont make fun of him and they have seen all sorts of kids and adults so they will not think he looks any different from anyone else. That is most likely his biggest fear. Either that it will hurt or that he is not normal. Isnt that most of our fears....especially down there!

Like Buddy said, I think they will do blood work and that hand xray to see how his bones are growing. Its that growth plate thing. Boys should be shooting up right now so that growth plate should be showing that. If its not, you have a problem plus his blood would show a lack of the growth hormone. If he has that, you could simply give it to him. I have known other people who had to do that and it is not a major issue. The kids grow up just fine.

I really doubt its the stimulant though. I had both my boys on ritalin since they were four years old and they are both well over 6 feet.

 

[slsh]

CM - we had the same situation with- thank you, though I'm thinking it was around age 12. Yes, the endocrinologist did have to check testicles and yes, thank you was not happy. He also got wrist x-rays to check bone plates. Actually, we went to endocrinologist in the first place because of a monster goiter thank you developed on Lithium, and he's the guy who picked up that things were possibly delayed. Turned out fine in the long run - thank you hit puberty probably around 14-15 and did have a growth spurt, but it was a lot slower than his brothers. He did end up being 6'4".

This would be a battle I would fight. Some of our kids have been on so many medications, and I think they just don't know the long term effects. While I don't think it's necessarily alarming at 14 to still be smallish, on the other hand puberty *should* be rearing it's ugly head. Is he showing any signs - mustache, cracking voice, etc?

I'd hesitate taking him off stims, especially since he's newly home from Residential Treatment Center (RTC) and *especially* if things are going well. Definitely wouldn't do it without input from MDs.

 

[crazymama30]

Oh, I won't do anything without talking to his psychiatrist and pediatrician doctor. Basically you all reinforced what I thought, it is time for me to be the mean mom. Hopefully the bloodwork and hand xray can help some. As for puberty? He has itty bitty bits of armpit hair, but no voice changing. He has always, since preschool, had hairy arms and legs. No mustache, no voice changes.

I guess I will wait to hear from pediatrician doctor after he talks to specialist, and then I will go from there. I think if I can somehow let his dad know what is going on, dad will reinforce it and that would help too.

 

[SearchingForRainbows]

I agree with those that said to take him to the pedi endocrinologist. difficult child 2 was very small for his age, showed no signs of puberty either. difficult child 2 had the same sort of experience as buddy's son. The endo only took a quick look, not very traumatic even for difficult child 2, who was also upset over having to have this done. He also had the hand x-ray. lab work. In addition, difficult child 2 saw a developmental pedi. He had an MRI because she suspected Fragile X Syndrome. To make a long story short, difficult child 2 finally had a growth spurt when he was a junior in high school. By the time he graduated at 19, he was over 6 feet tall! SFR

 

[BusynMember]

I'm the cautious type so, if this were my child, I would want him to see the endocronologist just to make sure...BUT...I would tell the doctor that he can't look at son's privates. They may be able to do an accurate analysis without checking him out down there. Or maybe he'll let dad see and dad can report if there is/isn't whatever they are looking for.

I have heard that stims do not really retard growth...that this is a myth, but I don't know what the truth really is. If both of you are small, he will be small too, but the size of a fourth grader is a little TOO small for somebody like ME to be comfortable without checking it out. But this is totally up to you. I would NOT make him bare his manhood to a doctor if he is not comfortable doing it...I'd keep that off limits and maybe wait another year if they insist.

 

[InsaneCdn]

I have heard that stims do not really retard growth...that this is a myth, but I don't know what the truth really is

The best info I've been given so far is that stims "may" suppress appetite... and THAT can slow down growth, but it's the lack of calories etc. rather than the stimulant itself... if that makes sense. If stims are working well, there are other ways of increasing appetite and/or caloric intake.

 

[slsh]

MWM - I understand respecting the boy's privacy, but... the exam was actually very important. Endocrinologist actually had sample sizes to compare to actual - apparently helped determine where he was in terms of puberty. If he's showing no signs of impending puberty, I would think addressing it sooner rather than later would be ideal.

Disclaimer: I may be biased toward insisting on exam because endo also found a physiologic abnormality that required surgery - might not have been found otherwise until permanent damage had been done. It was totally unrelated to delayed onset of puberty.

 

[BusynMember]

slsh, I hear you. I'm more like you. I'd rather have it done if it is requested and if seeing "it" was necessary, I'd have it done anyway. But that's me. I get every corner covered.

 

[pepperidge]

Do you think maybe he just wasn't mentally prepared for the pediatrician to check him out? How about if you processed it ahead of time with him, explain that adults get their privates checked out in physicals etc. --and if he has issues perhaps with how tall he is etc this will help doctor assess what the cause might be--explain about puberty etc. You know its embarassing etc. If he doesnt want you in room ok.... Don't know if he is amenable to some rational talk on this, probably not, difficult children being what they are. But if he is totally adamant I think I would talk to the doctor ahead of time and make sure the visit would still be worthwhile....

 

[TerryJ2]

We had this issue when difficult child tried out for football. Put his foot down and said NO!
Okay, no football.
The next yr, he caved.
I asked if he wanted me to leave the room. He said no. It was fast and he was fine with-it.
The dr did a great job of explaining why, and explained about hernias and how they go into the stomach. That was enough to open difficult child's eyes as to how this wasn't just a private part issue.
The others here have given excellent advice.
Also, I wondered about the growth issue with-stims, and a lot of it is that the kids don't eat. So I have relaxed our rules about not eating at night. Also, considering how many wayward stims we have found in between couch and chair cushions, I think difficult child was off of them as often as he was on them in the past 6 yrs!