Great question. Here's the subtlety - a binomial is a _polynomial_ with two terms. $\sqrt{x}$ is not allowed in polynomials, because $\sqrt{x} = x^{1/2}$, and fractional exponents are not allowed in polynomials. So while it is true that $x$ may take the value of something that makes $\sqrt{x}$ simplify nicely (i.e., $x$ may be a perfect square), that actually doesn't matter.
Similarly, a trinomial is a _polynomial_ with three terms, and a perfect square trinomial is a trinomial that is equal to the square of a binomial.
So $x^2 + 4x + 4$ is a perfect square trinomial because it's equal to $(x+2)^2$. But $x^2 + 4\sqrt{x} + 4$ is not even a trinomial, because of the $\sqrt{x}.$