A 5-year old girl with Down syndrome presents to your office for her annual physical

A 5-year old girl with Down syndrome presents to your office for her annual physical exam. Other than a history of a ventricular septal defect repaired at the age of 7 months, she has not had any significant health problems. The mother reports her daughter is thriving in her special education kindergarten class. When you plot her height on a Down syndrome growth chart, you note that she is now at the 10th percentile for height and the 75th percentile for weight, whereas she had previously been tracking at the 25th percentile for height and 50th for weight. What must you check before attributing her increasing bmi to diet and lack of exercise?

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