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When a child is born, parents have a picture of what the future holds for their son or daughter. How smart will he be? How athletic will she be? And not least of all, how tall will my child be? These are questions that often plague parents for years, causing worry and concern as well as a modicum of parental anxiety and distress. In this day and age, when unnecessary intervention is a concern, parents, and clinicians need to decide when short is "too short" and when watchful waiting with patience is the best treatment. Growth represents a sentinel for the general health of a child. Therefore, if a child's growth is below what is expected or the growth pattern is changed, parents often feel they have let their child down either genetically or nutritionally. In the younger child, overall weight gain receives greater attention than height. But as children grow into young adolescents, height becomes the fear. In the past, short boys and tall girls were considered socially impaired. Even into the 21st century, short males are often the brunt of many jokes and jeers. Society has coined the term "short man's syndrome" when a man may compensate in other ways because he falls below the average height. Ultimately, stature may be the deciding factor for success in physical and athletic activity. Find the right answer Now that it is obvious that male short stature in American society is negatively embraced, what can parents do if they have concerns about their son's height? Genetics, at least at this time, is somewhat fixed and if the parents are short, their children tend to be short. What can be done? Synthetic growth hormone has been available in the United States since the mid-80s and is theoretically in unlimited supply since it is synthesized in the laboratory. In addition, the side effects of laboratory-made growth hormone are minimal, especially when compared to pooled hormone from human brain tissue. However, to date, the indications for the use of synthetic growth hormone have been limited to growth hormone deficiency and growth failure secondary to a few syndromes and chronic diseases. Recently, more discussion has arisen regarding the benefits of growth hormone in children with short stature who have NO evidence of growth hormone deficiency. Nearly one-third of children receiving growth hormone do not have a syndrome or growth hormone deficiency. How are these decisions being made? From certain assumptions: 1) There is a psychological benefit to using growth hormone to accelerate growth. 2) Growth hormone, although not proven, may increase ultimate height. When these assumptions are made, who may be a candidate for growth hormone? A careful analysis of growth patterns may help identify a potential candidate for potential treatment. An appropriate analysis of the growth curve is the single most important step in the evaluation of the child with a growth problem. Although not sophisticated, accurate and consistent measurements and plotting on the growth curve are essential to early evaluation. Discussion of the following aspects of your child's growth with your physician may help in determining if your child may be a candidate for growth hormone. Absolute height: The absolute height may lend some information. If it is greater than three standard deviations below the mean, intervention may be indicated. Height velocity: The most important aspect of growth evaluation is the observation of a child's height over time, or height velocity. A substantial deceleration in height velocity between ages 3 and 13 may indicate pathology. Weight-to-height relationship: A child who is normal in weight but decreased in height may need further evaluation. Target height: This can be determined by the use of various formulas based upon parental height. A child whose current height percentile is grossly different from the target percentile at age 18 would be deemed inappropriately short relative to expected height. Bone age: Bone age, although very variable in interpretation, may help in determining if further evaluation is warranted. Assessment of body proportions: Relationship of upper body to lower body may give physicians further information about growth potential. Although this series of evaluations is helpful, it may not indicate the need for growth hormone therapy. If you have any concerns about growth, discuss this with your physician. Societal, psychological and family factors can influence the decision to use growth hormone. At the present time, science does not answer all of our questions. Therefore, a logical and reasonable approach to the use of growth hormone is warranted. Dr. Clyde Wesp is a pediatrician with Southern Orange County Pediatric Associates with offices in Lake Forest, Laguna Hills, Rancho Santa Margarita and Ladera Ranch and is affiliated with Saddleback Memorial Medical Center, Mission Hospital and Children's Hospital of Orange County. He is a member of the American Academy of Pediatrics and the Memorial Care Physician Society. If you have any questions or comments for Dr. Wesp you can e-mail him at askdrwesp@netscape.net. |
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