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Hilary
Hilary, Pediatrician
Category: Pediatrics
Satisfied Customers: 330
Experience:  9 years work experience in ny/nj and mother to my 6 year old son
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My 14 year old son is developmentally delayed - stature, maturity,

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My 14 year old son is developmentally delayed - stature, maturity, physical development is about age 11. He also has ADD. His doctor is treating him with Daytrana (3rd month) and he is receiving interactive metronome and neurofeedback therapy weekly. We held him back in 4K because of his delayed speech. Doctor is now concerned about his growth and development and suggests we visit a pediatric endocrinologist (again). We had him evaluated about 4 years ago and were told he was about 28 months behind in his development (growth). I'm just not sure what to do.
The endocrinologist is going to be able to address his growth delay from a hormonal perspective -- this means basically to determine is he is lacking sufficient growth hormone to qualify for treatment which involves growth hormone replacements. There are several levels of testing this involves to determine what his growth potential is without treatment, to determine whether this is an organic reason for the growth delay (by doing an MRI of the brain specifically the pituitary), doing an X ray of his hand (to determine what his bone age is - this will be able to help predict how much growth he has left in his long bones), and a series of blood work to determine hormonal levels and response to certain factors.

This referral will really not address maturity, developmental delay or his ADD. This is really to address his potential adult height and whether treatment will alter that. Even if you determine that he is deficient in growth hormone and that therapy would be helpful, you can still refuse treatment at that point - if you don't want to pursue therapy.

I feel that it never hurts to have all the available information. None of the testing is invasive- blood work, an x ray of his hand and an MRI of his brain - depending on how severe his developmental delay is - you would have to determine if sedation would be necessary for the MRI of if he can hold still for 30 minutes.

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Customer: replied 6 years ago.

I'm not sure what the priority should be. I'm considering taking him to a developmental pediatrician and to a pediatric endocrinologist. His maturity concerns me more than his size. Since he's 14, his size likely concerns him more. He's really small - wears a boy's size 10 and weighs about 70 pounds.

 

I'm just at a loss as to what direction to take first.

How significant is the maturity/developmental delay issues? If they are significant - my suggestion is that this may be a direction to see a developmental/genetic specialist first? Because the height and weight (small size for age) may be related to an underlying condition that would not be uncovered necessarily by an endocrinologist.

Has any workup been done in the past to evaluate these issues?
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Customer: replied 6 years ago.
No workup has been done previously. Ok. I agree. Thank you.
Then I would address the priority first. Best wishes to you and your family. Just try to be patient. A lot of these tests can take weeks to come back. It will be a trying time. I know it can be difficult not knowing, and remember sometimes that no news is good news, because sometimes testing is done on disorders that you certainly don't want to be the answer. Start down the genetics/developmental route and let those results dictate further testing/direction to take. I am sorry that this has not been done at a younger age.