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X-ray shows growth plates are still wide open. Suggested may be late bloomer. What is the problem?

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Pediatrician
Practicing since : 2009
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My son Is 15yrs 5 months and weighs 155lbs and his bone age is 15yrs old. the standard deviation is 14,2 months, his left hand x-ray growth plates are still wide open. I am 6'4 and his mother is 5'7. his 2 younger brother are in the 95% on the growth charts but this son has been around the 75%-80%. Our doctor said she cannot say with certain and did not want to go on the record ,but possibly believed he would be 6'1 to 6'3. She mentioned that he was a late bloomer category type kid. Both my wife and I were also late bloomers in growth as we grew an inch or 2 after 17 yrs old. Can you tell me how tall he will be. I would hope an endocrinologist can answer this. We just had his physical this week with x-ray.
Posted Mon, 11 Nov 2013 in Child Health
 
 
Answered by Dr. Gaurav Nigam 49 minutes later
Brief Answer:
Late bloomer,vitamin D

Detailed Answer:
Greetings.
so your child is falling between 75-95. But looking at the other history whr both siblings have attained height above 95 percent I presume the diet part is doing good. Also considering your height and your wife's height I would say there's no scope for familial low height.
but here are few points. As you have mentioned about wrist being wider than normal in the X-ray it would be great if you can get it read somewhere. speaking verbally that type of finding is also find in rickets. which is associated with low height as well. it is because of vitamin D deficiency. but in this case since there are no other findings. diet part is also good considering other siblings growth. but still if you want to get the vitamin D levels done just to rule out. Also try to give more importance to his diet. it should contain more of proteins.
but here it seems like a late bloomer to me. and yes a large proportion of children do fall in this category. but make sure the diet is good and supportive.
so talking about his adult height considering yours and your wife height it should lie between 6 to 6.4 if all goes well.
hope he attains his good height.
hope this helps.
Above answer was peer-reviewed by
 
Follow-up: X-ray shows growth plates are still wide open. Suggested may be late bloomer. What is the problem? 28 minutes later
my child that I am talking about is in the 70-76%, his brothers have always been in the 95%. That has always been our concern. his blood work showed well in protein. I will be getting the x-ray of his left hand on Monday, can I send a copy to you and you make a determination on a definite height based on the Greulich-Pyle method?

Thank you XXXXXXX
 
 
Answered by Dr. Gaurav Nigam 17 minutes later
Brief Answer:
Determination of bone age.

Detailed Answer:
Greetings.
I would be happy to help you. if you are getting a soft copy, do send me the picture. G P method is used for bone age determination.
will help you as much as I can.
have you ever got his vitamin D also done. or any other hormonal studies?
hope this helps.
Above answer was peer-reviewed by
 
Follow-up: X-ray shows growth plates are still wide open. Suggested may be late bloomer. What is the problem? 7 hours later
yes! we had all his blood work done! I can send you his report! I uploaded his blood work and will have a copy of his hand x-ray tomorrow. Doctor! this is very important to us ,so if you can please consult your peers and give us a detailed version of your findings.

 
 
Answered by Dr. Gaurav Nigam 25 minutes later
Brief Answer:
Not readable.

Detailed Answer:
Greetings.
I did see those reports. But for some reason it's very hazy and nothing is clear. Though I can make out that nothing majorly is written in dark that is nothing looks abnormal as such. but again since it's not readable so I am not sure.

If you can please send me a more clear version of it it would be great.

Hope this helps.
Above answer was peer-reviewed by
 
Follow-up: X-ray shows growth plates are still wide open. Suggested may be late bloomer. What is the problem? 3 hours later
can I send this to your email as it is a picture and is a very clear picture?

if there is any specific questions on blood work results you would like if you cant read I could also write them down for you! or again, I could send this as attachments to an email which would be much better!
 
 
Answered by Dr. Gaurav Nigam 8 hours later
Brief Answer:
vitamin d,other hormonal levels if done.

Detailed Answer:
Greetings.

I want to know the blood report results for vitamin D.
Also if there are any reports pertaining to any hormonal levels such as growth hormone levels, I would like to look into it.
Also kindly tell me if there are any abnormal reports i.e. out of the range.
and do send the copy of the X XXXXXXX

You can mail the reports to YYYY@YYYY with subject as "Attn: Dr. Gaurav Nigam"

Regards
Above answer was peer-reviewed by
 
Follow-up: X-ray shows growth plates are still wide open. Suggested may be late bloomer. What is the problem? 1 hour later
1st page! for XXXXXXX marcons blood wook for bone check on height prediction!

Thank you, XXXXXX
 
 
Answered by Dr. Gaurav Nigam 18 minutes later
Brief Answer:
seen the reports.

Detailed Answer:
Greetings.

I read one of the pages which states about glucose, potassium etc.
And just now also got your other report.

I would be able give you a valuable opinion once I get the X-ray report too. Let me know the X-ray report as well.

Regards
Above answer was peer-reviewed by
 
Follow-up: X-ray shows growth plates are still wide open. Suggested may be late bloomer. What is the problem? 12 hours later
Hi doctor! attached is his x-ray. I am also curious if the radiologist may have been off a few months! could that be possible in their determination in the bone age. When you have your peers look at this hand, do they give an opinion or is it more of a fact of age? again, this is very important to our family as you know.

hi doctor! have you been able to evaluate the x-ray?

Thank you, XXXXXXX
 
 
Answered by Dr. Gaurav Nigam 16 hours later
Brief Answer:
Yes, I was able to evaluate X-ray...

Detailed Answer:
Greetings,

Yes, I was able to view the X-ray.

According to your history your son is 15 and a half year old. And as per the X-ray, the bone age is also around 15 years as well. I don't find any concerning issues here.

Now, height depends on two factors - one is the genetics i.e parental height and the other is the environmental (environment and hormonal milieu). In Nicks case, according to your height and that of your wife, I can calculate that he would approximately be around 5.9-6.3 feet (adult height). We derive at this height based on formula and do not consider the impact of environment and other factors in the final outcome.

But as I mentioned earlier that in some cases it's the late bloomers type of story. May I know your son's present height in cms?

Regards.

Regards.
Above answer was peer-reviewed by
 
Follow-up: X-ray shows growth plates are still wide open. Suggested may be late bloomer. What is the problem? 3 hours later
XXXXXXX is 177.5 cm. our doctor said he will be at least 183cm. I am 193cm and my wife is 170,18. As I stated to you earlier last week our concern is a precise height. Can you give us that what the information we gave you or can you pass this on to you peers and discuss. Your answer was to broad, can you be more specific at all. I thought i was communicating with an endocrinologist who is a specialist in height determination based on bone x rays of the left hand and wrist. Please give me a thorough explanation please as we move forward or did I make a mistake assuming could get that answer from this site.

Again, thank you,
XXXXXXX
 
 
Answered by Dr. Gaurav Nigam 17 hours later
Brief Answer:
Done enough research and spent a lot of time

Detailed Answer:
Greetings
As I have told you earlier, I can give you a range and these ideas are predicted height if everything goes well. All the formulas are meant for estimation and not precision. Please understand it. Genetics have a large role and they can determine the precision. I have referred to lot of literature, spent enough time and peer reviews and then mentioned your child’s bone age. I tried to be as simple as possible. This is my opinion with the information provided.
Any doctor will give you the best-calculated estimation. If you are looking for Endocrinologist opinion you should choose 'Ask A Specialist' product as they undergo intense training post residency.
Hope this helps.
Thanks for following up with the answers.
Regards.
Above answer was peer-reviewed by
 
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