Question

A 7 year old girl is brought to her physician because her parents are concerned that she is shorter than all of her classmates. The patient's past medical history is benign, and she is otherwise healthy and thriving at home and at school. Her mother is 61 in. (155 cm) and her father is 67 in. (170 cm) tall. In reviewing her old records, it appears that her growth velocity is normal. Physical examination shows the child to be in the 3rd percentile for her age for both height and weight. The patient is Tanner stage 1 and is otherwise developmentally appropriate. The remainder of physical exam is normal. What is the most appropriate next step in the management of this patient?

A. Reassurance
B. Bone age
C. HIV testing
D. Serum IGF-1
E. Serum GH level

Answer 1

The most appropriate next step in the management of this patient is to perform a bone age assessment.

Step-by-step explanation:

The most appropriate next step in the management of this patient is to perform a Bone age assessment. Bone age is determined by taking an X-ray of the wrist and hand, which can help estimate the child's skeletal maturity and potential for growth. Since the patient is in the 3rd percentile for both height and weight, it is important to assess if her bone age is proportional to her chronological age or if there is a delay in bone maturation.