Q&A: My 21-month-old seems to be on the small side. Should I be concerned?

Most times when comparisons are made among humans, be it height, weight, intelligence, etc., most of us fall in the middle, with only a few falling at the extremes at either end. Though normal people do live at those extremes, sometimes those differences are due to illness or abnormalities, such as genetic problems, which can explain mental retardation or thyroid deficiency, or even extreme short stature.

In pediatrics, we look to smooth and normal growth as an important indicator of good health. Your pediatrician is asking for some of the standard tests that are done when the decision is made to make sure no hidden illness is the cause for unusual growth. The urine test is to confirm that there is no infection and also that the kidneys are working properly.

That's a judgement call that only the doctor seeing your son can make. It would be more clearly necessary if your son were falling off his own curve, which you say he isn't. Is it likely to uncover a big problem? Well, many times is doesn't, but the few times is has in my practice, it's a relief to be able to address the problem sooner rather than later.

The bottom line is that you are his mother and need to feel comfortable with what is being done to your son. Consider a second opinion to get another perspective on the issue (but that someone will need to see and examine your son), or at least ask to sit down with your pediatrician to voice your concerns, get better explanations from her and hopefully work out a plan that gets the important information with less trauma to you and your baby.

Make sure you do boost the iron in his diet though, as this is the most common cause of anemia in toddlers.