Short Children Too Often Viewed As Handicapped, UF Researchers Say

December 11, 1996

GAINESVILLE —The availability and aggressive marketing of synthetic growth hormone can lead to short stature in children being treated as a disease or disorder when often there may be no real problem, say professors at the University of Florida.

“There is a problem with heightism,’ which equates acceptability and success with stature and tends to make normal short stature a disease,” said Dr. Arlan Rosenbloom, professor of pediatrics at UF.

Short stature can be an indication of problems with the child’s endocrine glands, which secrete hormones necessary for normal growth and development, or other serious problems. But it also could be normal development for a child who is either inherently short or delayed in reaching the adolescent growth spurt.

“Our definition of short stature is the shortest 5 percent of children,” said John Kranzler, associate professor of school psychology at UF. “Ninety-five percent of these shortest children do not have endocrine problems.”

Studies in the last 30 years indicate short children may be more socially and academically handicapped. There is a question, however, whether these studies are biased; the children in the studies may have been referred to clinics because of behavior problems thought to be related to their short stature.

“There are some studies that suggest we are seeing a biased sample,” Rosenbloom said. “Many children with short stature do not have developmental or social problems. There are a lot of short people who do very well in life.”

To determine if some tests had a bias, Rosenbloom and Kranzler designed a study comparing children with normal short stature referred to clinics with short children who were not referred to clinics.

“There is some suggestion that there are indeed differences between referred and non-referred short youngsters in the various tests of academic achievement, intelligence, parent and teacher behavior rating scales and family functioning,” Rosenbloom said.

Previous studies indicating short stature is related to poor achievement have led to short stature being treated as a disorder. The vigorous marketing of synthetic growth hormone and the finding that some children respond to hormone treatment even if they do not have deficiencies, led many parents of short children to enroll their children in growth hormone treatment.

“One reason that short stature is viewed as a disease is the availability of recombinant

growth hormone and an aggressive market to promote this hormone,” Rosenbloom said. “This has led to an overuse of growth hormone. Many doctors are worried that we are jumping into growth hormone treatment without appropriate counseling, which is our traditional first weapon in our arsenal, and is very effective for a problem that is not a disease.”

For children having problems because of their short stature, there are less costly options.

“For 30 years or more we have been using Oxandrolone, a low potency androgen which doesn’t produce masculinity but will promote growth,” Rosenbloom said. “This will not have a long-term effect. But for children who are having trouble related to their growth, it can help in social adjustment and achievement if the child’s short stature is causing problems. Very low dose testosterone injections once a month are similarly effective.”

Most short children do not need any therapy beyond counseling. Parents often are more concerned about the child’s size than the child is, said Rosenbloom.

“If I see a child who is as bright as a new penny, who is making straight A’s or B’s or in some cases even C’s, that is, achieving to the best of his or her ability, competing in gymnastics, wrestling or soccer and is socializing well, just because this youngster is short, unless it is due to a hormone deficiency or an absorption problem or a cryptic illness, I don’t deal with it as a problem,” Rosenbloom said.