How to manage a grossly short and underweight child?

Q: My daughter is 10 years old but looks like a 6 year old. She weighs approx. 25 kg and her height is about 3 and half feet. I have got her checked up by many physicians but all of them said there was no problem. She used to go to toilet immediately after meals when she was about 4 to 6 years but even now she faces the same problem, though not frequently. Sometimes she vomits immediately after eating or taking milk. Otherwise she is physically and mentally fit. I live in Delhi and will appreciate if you can diagnose her problem or suggest me any clinic where I can get her thoroughly checked up for any deficiency.

A:Your daughter is grossly short and underweight for her age. She is even short for her present weight. Even though her mother is not very tall, the expected height of your daughter is about 159 cm (5 feet 2.5 inches.) and it is unlikely that she will attain that potential with the present rate of growth. Her present height is far below the expected percentile suggesting that she may have an underlying hormonal deficiency such as hypopituitarism with growth hormone deficiency or hypothyroidism. It is essential that you should seek the advice of a competent paediatrician preferably a paediatric endocrinologist in a hospital like AIIMS or a good private hospital where such facilities exist. She will need a good clinical examination to rule out a genetic, orthopedic or hormonal disorder. This will include x-rays to determine bone age, blood tests like complete blood counts, biochemistry to rule out a chronic systemic disorder followed by selected hormonal tests.