When you worry about being short

by drnieman on November 11, 2012

in Uncategorized

THE SHORT CHILD

Q My 11 year old son has always been one of the shortest boys in his class. It does not bother him too much yet, but I am curious if he will be a candidate to get growth hormone to make him taller. Is it safe to modify his height by using a hormone?

A  Your son is very close to entering puberty, a time when linear growth accelerates.  Most children who are given growth hormone, start therapy around ages 10 to 12 years.

After thirty years that I have cared for children, I consider the debate about giving growth hormone to short—but otherwise normal children—one of the most controversial debates. Some say it’s cosmetic and that the cost is too expensive; others claim that even if at best, one can only add 2 to 3 inches, it is worth it.

First of all it is important to ensure that your son is healthy. Conditions such as Celiac Disease or thyroid problems should have been ruled out by now. In addition, a bone age should have been done (it is an x -ray of the wrist, telling us his skeletal maturity) A number of other tests are also done to ensure there are no genetic, gastro-intestinal or endocrine conditions accounting for his smaller size.

The actual growth velocity is important. Over time, we track both height and weight on standard growth charts. If he consistently follows the same pattern at a lower percentile, it will be reassuring. (As opposed to dropping off his growth chart over time)

The family history is key. There is a formula to predict his future height based on the height of both parents. For example, the maximum predicted height is the mother’s and father’s height combined, divide that by 2 and then add another 6.5 inches for a boy or 1.5 inches for a girl.

Another very rough rule of thumb is to take a person’s height at age two and double it. That supposedly is very close to one’s  predicted adult height.

Most children who are given growth hormone are below or close to the first percentile before therapy.

The cost of this medication is astronomical. It runs between $20,000 and $30,000 per year and involves numerous weekly injections. The child has to miss school to see the endocrinologist (community-based pediatricians do not administer this medication; as a rule it is done via endocrinology experts)

The synthetic growth hormone was given the green light in 2003. Eli Lily is the company who first launched synthetic growth hormone and at that time some called growth hormone “Miracle Gro” for kids. (In the mid eighties growth hormone was obtained from cadavers and, sadly, some patients contracted Creutzfeldt –Jacob Disease, a slow viral infection of the central nervous system)

If a child receives this medication over three years the growth is expected to go from the first percentile to, at best, the 5th or tenth percentile—still around the lower range of normal. For someone who will be too short to drive a car, or reach shelves, this small difference can be crucial. However, for other normal but short children, many experts debate the ethics and social aspects of subjecting children to treatment—especially if the child is not concerned but parents are.

The treatment is usually stopped when the growth plates have closed. At the moment the data on the safety of growth hormone seem to be reassuring, but some skeptics remind us that it has only been in use since 2003 in greater numbers. They want to see long term data before they are 100% sure.

Stephen S. Hall, a writer for the New York Times, wrote a nice summary in lay language about the history and current dilemmas of being short. (NYT October 16, 2005) He is short himself and that was one reason he choose writing as a career.

It is well known that short children are teased. It is not uncommon to be called “Shrimp” or “Shorty”. They may also be mistaken for being younger than their actual age. Some parents fear that when their son grows up he will make less money, find it hard to get a date or suffer bias. Numerous studies done on the quality of life failed to confirm this.

Tom Cruise, a successful actor, is short (close to 5 feet 7) , but others point out that no US President in recent years was short. Napoleon was 5 feet 6 inches and looked shorter because his guards were taller. The average Canadian male is 5 feet 9 inches.

The bottom line is that in an otherwise healthy child the use of growth hormone is expensive, it requires weekly visits to an endocrinologist and the final outcome may allow a patient to get to the adult height a bit sooner. At best one can expect no more than an additional 2 inches; perhaps 3 and that a child below the first percentile can expect to get to the 10th percentile. Meanwhile society debates the psychosocial disadvantages of being short despite numerous examples of successful short people who are normal psychologically, but who admit they were teased as a child.

 

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