You are asked to a see a 7-year-old boy for concerns over short stature.
Thomas attends with his mother who states that his height has dropped down the centiles and she has noticed that he will wear out his shoes before he grows out of them. He is still in last year's school uniform and he has a 5-year-old brother who is about to overtake him in height.
Thomas appears to be otherwise fit and well but does take Movicol for constipation. He has no known drug allergies and was born on time.
He is one of three children with an older sister and a younger brother. His mother and father are fit and well with no relevant family history of note although his father was adopted so history on his side of the family is limited.
Thomas is 111.5cm tall and weighs 23kg, it is the day after his birthday but his mother says that he was too tired to enjoy his party. It is warm in the clinic room but Thomas insists on keeping his coat on until you examine him. His examination is unremarkable.
Image from Pharmacia & Upjohn teaching resources