My child is shorter than most of his peers. Although my son comes by it naturally - his father and grandparents are short - I am somewhat concerned that he may be teased if his shortness is not treated. I have also read that short adults make less money. Is this true?
The term "Tall, dark and handsome" is hardly new. Current values in our culture continue to over-emphasize height as a sign of success and influence. Frequently, assumptions are made that a tall, teenage boy is far more likely to get a date than his shorter peer; tall adults are more likely to be employed, even promoted than short adults; and all influential male leaders are over 6 feet tall. In fact, a recent study indicated that the past six occupants in the Oval Office were at least 6 feet tall.
Obviously, there are many exceptions to this line of thinking. For instance, Napoleon was a short leader. The influential, Hollywood actor Michael J Fox is not very tall either. There are also a number of short yet successful singers, comedians and TV personalities with a net worth far over a million dollars.
Two influential publications (Pediatrics, 2004; 114:744-750 and Endocrinologist, 2001; 11:85-145) by Dr. D.E. Sandberg indicate that social adjustment as well as the quality of life of the majority of children and teens with short stature all seem to be normal, without any poor psychosocial outcomes. Other authors have published similar data.
Yet, there are occasional, contradictory studies. One published two years ago in the U.K. indicated that tall individuals from the UK are likely to make more money. Other studies have also indicated that shorter children are more likely to be bullied.
Short children often have parents who are also short. Or sometimes a child simply grows at his or her own speed - slow at first, with a growth spurt as a teenager. Normally, a child grows at the following rates:
- Between birth and one year: 23-28 cm per year.
- Between one and three years: 7.5-13 cm per year.
- Between three years and puberty: 4.5-7 cm per year.
- During puberty: 4 cm per year on average, up to age 14 or 16 years.
(Note: Much of the growth in height depends on when the child enters puberty).
Most pediatricians tend to rule out trouble by completing a thorough history and examination. In terms of further testing, there is one easy test any physician can do called a bone age. This involves an x-ray of the bones by a child's wrist area. If the test shows a delay in the bone age, the child is most likely to be a "late bloomer". A late bloomer is the youngster who has almost everyone concerned, but as was the case so often with a parent or grandparent, he or she is just off to a slow start.
If the bone age is the same as the child's chronological age, and the parents are also short, the odds for that child to be tall are quite low. This is especially true when the child consistently follows a lower curve on the percentile forms, which are typically completed by their doctors during an annual, physical examination.
In 2003, the FDA approved the use of growth hormone therapy (GHT) in children who are not deficient in growth hormone, otherwise known as idiopathic short stature (ISS). Previously, GHT was mostly seen in children with conditions such as chronic renal failure, Prader-Willi Syndrome, Turner syndrome, and those deemed small for their gestational age. These conditions are markedly different from a parent’s concern over a normal, healthy child who consistently grows at a slower but very consistent rate.
The use of GHT in children with ISS has lead to much controversy and debate in the pediatric literature, especially among endocrinologists. In a powerful overview found in the July 2006 issue of Pediatrics, referenced by close to 50 other studies, Dr. David B. Allen from the University of Wisconsin asked this provocative question: Growth Hormone Therapy for Short Stature: Is the Benefit Worth the Burden?
The best outcome one can expect if growth hormone injections are given at least three times weekly is 1 cm per year of treatment. Putting it in different terms, the cost of attaining one inch of adult height is $35,000 USD, whereas treating adolescents can exceed $50,000 USD per year.
Few, if any, Canadian pediatricians in major metropolitan areas administer GHT via their own private clinics. At the local Children's Hospital, the number of ISS children receiving growth hormone treatment runs quite low.
Growth hormone was previously obtained from cadavers. This outdated practice was abandoned once physicians became aware of the risk of infections such as Creutzfeldt-Jakob disease. The use of synthetic growth hormone is regarded as safe, although there are some concerns such as higher insulin levels as well as damage to the pancreas, heart, and bones (especially the hips and spine). At one point, there was even a concern about an association with leukemia, but according to a Pediatrics publication this concern seems to have faded.
The bottom line is that the vast majority of short, healthy children are normal and will grow up just fine in the end. My own explanation as to why some short children do not experience negative psychosocial outcomes is they have peers, coaches, teachers and, most importantly, parents who all support and encourage them to focus on their true talents. Ultimately, they thrive in life.
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An informed parent is ... an empowered parent.