Worried that your son's height -- or lack of it -- will ruin his life? John's father Thomas was. John was the shortest boy in his sixth grade class -- barely at the 10th percentile on his growth chart. "Can't you give him something, growth hormone?" Thomas repeatedly asked after my history, physical and endocrine work-up showed John was otherwise healthy. "I thought he'd be taller than me."
"It's possible, but not likely," I had to admit. Thomas was only at the 25th percentile in adult height himself, and shorter relatives were common in his family. Further questioning revealed Thomas' anxiety that John would be teased, discriminated against or experience a poorer quality of life. I couldn't grant Thomas' request to prescribe growth hormone. The FDA has only approved the injections for patients with disease-free short stature if they are at or below the 1.2 percentile.
Fortunately, there's good news for Thomas and other parents with healthy children who just aren't as tall as their peers. It's okay to be a short kid, and research shows it. A study in the September 2009 Journal of the American Academy of Pediatrics found that there were no significant differences between short and non-short sixth graders in all the life quality parameters studied -- except one.
Shorter 12-year-olds were more likely to report being teased by classmates, but otherwise were not different from the taller children in screens for depression, optimism, asocial behavior, exclusion by peers, social support from peers and popularity. And teachers polled didn't report differences between short and non-short students in peer victimization.
During a private interview, John himself agreed that he didn't have problems at school and actually had lots of friends. Sure, it'd be nice to be taller, he said, but he shrugged off any more serious concerns. If his friends ever teased him about his height, he'd tease them back about something else and they'd back off. All together, he was happy and doing well. "It's my Dad. Tell him I don't want any shots."
Thomas' worry about his son was understandable but unnecessary. John was well-adjusted and didn't need or want medical intervention -- his height was only an issue at home. Reassuring Thomas that his son's behavior, development and psychosocial adaptation were normal helped Dad become more comfortable with and accepting of John's height.
There are many causes of short stature in children and teenagers that can be diagnosed by working with your pediatrician. These include:
•Genetic conditions such as Down Syndrome
•True growth hormone deficiency
•Nutritional deficiencies, eating disorders and gastrointestinal conditions
•Systemic health conditions such as thyroid disease, autoimmune disease, cystic fibrosis
But some children are naturally short, and, like John, often come from families with short individuals. One of my pediatrics professors years ago always used to return to the old homily: "You can't find oranges under an apple tree." Today, trying to change an apple into an orange isn't healthy for the child or his parents either.
I saw John a year later for a physical. He'd grown a bit, following the line on the 10th percentile, and was still doing well with friends and school. In fact, some of his friends had asked him to scrimmage with them on the basketball court -- and John's agility got him an invitation to play on his school's basketball team, which he eagerly accepted.
"Never thought I could play basketball being on the short side," Thomas admitted out of John's earshot. "I'm so glad it didn't stop him -- I didn't stop him." Nodding, I returned his smile.