Should I consider growth hormones for my short child?

This question has been one of the most-often-asked in the field of pediatric endocrinology ever since 1985, when growth hormone was made available in large amounts. The approved use of growth hormone is for children who fall below the first percentile on the standard height charts and whose short stature is idiopathic (without a definable cause). That means the child should be evaluated first by a pediatric endocrinologist and found not to have a condition remediable by other means or a serious condition for which growth hormone is already indicated, such as growth hormone deficiency, chronic kidney disease or Turner syndrome.

The reason to prescribe growth hormone would be to raise adult stature significantly or to intervene in severe psychological difficulties due to short stature. The side effects of therapy are usually mild, with physical effects ranging from headaches to joint and muscle discomfort to scoliosis.

But in my opinion, the most important side effect is that of "unmet expectations." The data for additional growth show an increase of approximately 2 inches after five to seven years of GH therapy, at an approximate cost of $50,000 per inch. In other words, a child whose height is projected to be 5'1" before intervention would potentially turn out to be 5'3" after daily injections over a number of years. I must emphasize this relatively minor change in height: After years of costly treatment, most patients still will be in the short adult category once fully grown. It's a choice each family needs to make, with a clear understanding of all the information available to them and the consultation of a pediatric endocrinologist.