If your child is healthy but short, don’t assume short stature is a problem that needs medical treatment.
Growth hormone deficiency, which occurs when the pituitary gland doesn't make enough growth hormone, can stunt a child’s growth. The condition has been treated for decades with human growth hormone (hGH) injections. But until 30 years ago, hGH was scarce because it could only be derived from human cadavers – so its use was limited to children with a severe growth hormone deficiency.
However, the development of recombinant hGH was a game changer. First available in 1985, this synthetic form of hGH became widely used to help youngsters with physiological causes of growth hormone deficiency that hamper normal growth. Then in l995, the Food and Drug Administration approved hGH for other uses – including boosting the stature of shorter-than-normal children who don’t have medical problems. Soon thousands of youngsters were prescribed hGH to hopefully make them taller eventually.
In several studies over the course of a decade, researchers from the Children’s Hospital of Philadelphia have found short boys are far more likely than short girls to be referred to medical specialists for evaluation and to end up being prescribed hGH injections, which can continue for years. The treatments, which can boost height by about one to three inches by adulthood, cost tens of thousands of dollars a year and aren’t always covered by insurance, placing them out of reach of many families.
For a recent study, Children’s Hospital pediatric endocrinologist Adda Grimberg, MD, and co-researchers conducted focus group discussions with parents and surveyed about 2,000 parents from both city and suburban areas. They wanted to learn why parents seek hGH treatments for their shorter-than-average but healthy children.
"We set out to answer a new question," explained Grimberg, who headed the research. "What are the factors, perceived or real, that drive some families to seek medical care for short stature?"
The results of the study showed about half of the parents worried their youngsters, primarily boys, would suffer psychologically and socially because they were short. Almost 40 percent said growth hormone treatment for short kids was important to help a child become a successful adult, too.
But when possible side effects of the treatment were discussed, the parents expressed concern. Over half said it was important to know about the relationship between a health issue and short stature. They also wanted to know how well hGH works and what side effects were possible.
Fully understanding possible risks and benefits is important because additional research by Grimberg’s team revealed parents often find biased growth hormone information on the internet on websites that underreport the costs and potential risks of hGH.
In a review of the challenges and choices for treating short children with hGH, University of Wisconsin pediatric endocrinologist David Allen, MD, noted it’s important for parents to have their short child evaluated to make sure they have no underlying health problems. If the child is healthy and growth hormone treatment is an option, it’s reassuring to know hGH has an excellent record of safety during the time most children take it, according to Allen. However, he pointed out potential later risks in life from hGH remain unknown. Some researchers have expressed concern growth hormone treatments could increase the risk of diabetes or certain cancers over time.
If you worry your child’s short stature will put him at a disadvantage in life, there’s good news. Studies show short children (and short adults, too) aren’t less happy than their taller peers, and there's no evidence that treating short, healthy children with hGH will improve their quality of life, according to Allen.
In fact, University of Michigan pediatric psychologist David Sandberg, PhD, thinks parents worry too much about how their shorter-than-normal but healthy kids will fare in social situations. His research found students who were considerably shorter than their peers in early school years were often thought of as younger than they really were by their classmates. However, that didn’t make the short kids less accepted or less popular, especially by the time they were in high school.
Young people are normally resilient, and the majority do well facing challenges, including being shorter than some other kids, if they have a supportive family, according to Sandberg.
February 27, 2020
Christopher Nystuen, MD, MBA