BMJ Case Reports 2011; doi:10.1136/bcr.01.2010.2640
  • Reminder of important clinical lesson

Growth monitoring still has a place in selected populations of children

  1. J C Blair1
  1. 1Department of Paediatric Endocrinology, Alder Hey Children’s Hospital, West Derby, Liverpool, UK
  2. 2Department of Paediatrics, Whiston Hospital, Prescot, Merseyside, UK
  3. 3Department of Paediatric Neurology, Alder Hey Children’s Hospital, West Derby, Liverpool, UK
  4. 4Department of Paediatrics, Southport and Ormskirk Hospital, Ormskirk, UK
  1. Correspondence to J C Blair, jo.blair{at}


In 1998, a multiprofessional group developed a consensus on growth monitoring in the UK. While routine serial measurements were not recommended in healthy children, it is clear that there is a subset of children at increased risk of growth-modifying disease who may benefit from growth monitoring. This subset includes children with genetic disorders at increased risk of thyroid dysfunction. Symptoms and signs of thyroid dysfunction are non-specific in the early stages of disease and are easily mistaken for features of an underlying genetic disorder. In this article, we report the case of a 2.8-year-old girl with 18q deletion syndrome who was profoundly weak, hypotonic and poorly responsive at diagnosis of Grave’s disease. She was tall and her bone age was 2 years advanced, indicating long-standing disease. Growth monitoring of this patient should have enabled earlier diagnosis and avoided a serious and potentially fatal episode.


  • Competing interests None.

  • Patient consent Obtained.

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