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Is short stature a problem? The psychological view

Department of Endocrinology and Metabolism, Peninsula Medical School, Plymouth, UK

(Correspondence should be addressed to L D Voss at the EarlyBird Research Centre, Child Health, Level 12, Derriford Hospital, Plymouth PL6 8DH, UK; Email: l.voss{at}phnt.swest.nhs.uk)

Abstract

The use of GH in short normal children remains a controversial issue as physicians and parents alike are under continuing pressure to identify and to treat such children. Before asking who might respond to growth-promoting therapy, we should first ask who needs it. Rational intervention assumes some abnormality, physical or psychological, that can be corrected. Where short stature is the result of GH deficiency, the case for intervention is clear and uncontroversial. Where there is no clear deficiency, treatment can be regarded neither as replacement therapy, nor as corrective, but simply cosmetic. However, there might be a case for therapy if there were clear evidence of an association between short stature and psychosocial dysfunction. The common perception that short stature is an inevitable handicap has been founded on unreliable evidence, largely clinic-based studies, where children experiencing the greatest difficulties are likely to be found. Such reports, unless challenged, can only lead to an increasing demand for treatment, both from and for those who were previously unconcerned. The Wessex Growth Study recruited an unselected cohort of short normal children, not from the clinic, but from the community at large, and has challenged the widely held belief that short stature is an inevitable disadvantage. The progress of these children, followed over some 13 years, has given little cause for concern. Indeed, this study, and others subsequently, has demonstrated the normality of the psychosocial functioning of the short normal child.