Short normal stature and psychosocial disadvantage: A critical review of the evidence

Physicians and parents alike are under increasing pressure to identify and to treat short stature, but intervention implies the presence of some patho logy, physical or psychological, that can be corrected. Where there is true GH deficiency, the argument for replacement is uncontroversial. It is less compelling where GH 'insufficiency' is diagnosed. In the case of the short , but otherwise normal, child the indications for therapy are even less cle ar. Short stature, per se, is clearly not a disease, in spite of the percep tion by some practitioners that the rate of growth of such children is abno rmal. Short stature is, however, commonly perceived to be associated with s ocial and psychological disadvantage, yet many of these misperceptions abou t short stature can be challenged. A critical review of the literature pert aining to the psychosocial correlates of short stature uncovers much flawed evidence. Most importantly, the belief, widely held by paediatricians, tha t short children are likely to be significantly disadvantaged, has been fou nded largely on data from clinic-referred samples. In such studies, childre n with real (or perceived) behavioural or academic problems are likely to b e overly represented. Publications arising from such studies, however, inev itably lead to an increase in the demand for treatment both from and for th ose who previously had no such concern. In contrast, data from a well contr olled, prospective population-based study suggest the essential normality o f the short normal child. Parents and children alike should be reassured by these findings. In the absence of clear pathology, physical or psychologic al, GH therapy for short but otherwise normal children must therefore, in m ost cases, be deemed cosmetic, raising issues as to the ethics of so-called "plastic endocrinology".