Birmingham-- This Fall, I joined the ranks of the Soccer Moms. Already, I can tell, the whole sports thing is not going to be easy for me. You see, my four-year-old son Jack is the smallest on the field. Once, during practice, a teammate actually picked him up and carried him because he was afraid Jack would get hurt! I worry more about the emotional bruises. Nine year old Parker Hartline understands what it's like to be the smallest kid on the field. Until this year, he didn't even rank on the Standard Growth Chart.
"I just don't really like being small that much. It's not an advantage. It's not a disadvantage but I'd rather be taller because most taller people do better things than smaller people. (Galloway: "Like what?") Like Yoa Ming he's like seven foot 8 and he's a way better basketball player than most people."
Hartline has growth hormone deficiency. Aside from being short, kids who don't make enough growth hormone are at risk for numerous health problems down the road. Growth hormone therapy is the answer and comes in the form of daily injections. Although the thought of giving her son a shot every day for years was scary to Parker's mom, Penney, the potential benefits outweighed her fears.
"We looked at all the consequences and all the pros of it. If we could possibly help our child who is who was projected to be a male at 5'2" to become 5'6" or 5'7" in today's society that is a huge benefit just those extra three or four inches."
A recent survey of Fortune 500 companies showed CEOs are, on average, three inches taller than other mere mortal men. And last year a Gallup Poll confirmed that Americans believe stature has important consequences, particularly for men when it comes to success. In his new book, Size Matters, medical writer Stephen S. Hall delves into the issue of "heightism" in our society.
"People are just very aware of height, of physical size, physical shape, every aspect of physical appearance obviously is a very important part of our social awareness. And I think some of those attitudes and vulnerabilities are shaped by our childhood experience."
Those vulnerabilities and attitudes influenced Penney Hartline's decision to commit to growth hormone therapy.
"You never want your child to be singled out for a reason and when they hit elementary school. And that's what we tried to prevent is we tried to be proactive in our child not being the short stuff or the little pee wee or the pip squeak, you know every class had one. And you know children are sensitive and children are cruel."
In 2003, the drug companies who make growth hormone used the argument of psychological benefits when they appealed to the FDA to approve the therapy for kids with Idiopathic Short Stature - or ISS. These are healthy kids who, like my son Jack, are very short but test in the normal range for growth hormone production. The shift in the drug's designation set off a controversy that continues today. Five foot nine inch mom Laurie Hereford and her six foot husband never dreamed they'd be dealing with the issue until their son Faulkner's growth slowed.
"We were very hesitant at first my husband and I about giving growth hormone injections. We just like well, God created him this way. This is the way he should be and there's something good about this."
But Faulkner's twin brother was several inches taller, and even his younger brother shot up past him. When his test came back with borderline results, Faulkner begged his parents to let him try growth hormone therapy.
"He grew a little over a six month period and his twin brother grew twice that much without doing growth hormone and without eating fruits or vegetables too. So it didn't make any sense that we were giving shots every single day for six month and saw absolutely no results."
The average height gain for those with ISS - those short, but otherwise healthy kids - is about 1.5 inches over four years of treatment. And it comes with a hefty price tag: $20,000 to $30,000 a year. Earlier this year, researchers from the University of Michigan did the math and found the cost was more than $52,000 an inch! - roughly the same price as a year at Harvard, including room and board. Is saving your child from the shame of being called "peewee" worth it? It's been over three years since the FDA's ruling, Stephen Hall is doubtful.
"Children who make enough of their own growth hormone, they don't see any psychological difference, in fact, the use of the drug has a modest impact on increasing height and as one pediatric endocrinologist told me, it fundamentally does not change the "bin" that one's in. Meaning that if you're a small child and you use growth hormone you will still be a small child at the end of the treatment which is very expensive and could go on for a number of years."
Hall, who has become a respected journalist -- despite his five foot five and 3/4, stature -- contends that being short has its benefits.
"It just gives you some skills to cope with things when they're not going your way. Or when the world is unfair to you as it is if you seem to be shorter than 99% of your peers. There's gotta be some kind of carryover psychological benefit. If you survive that, learn to cope, gives you skills in adulthood that are probably very valuable."
But now, there may be more at stake than a child's self esteem. Last October researchers from The Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine released a study linking increased levels in growth hormone with the growth of cancer cells. This means normal, short children who undergo growth hormone treatment may be at risk.
Back on the soccer field, Jack defends the goal against a larger opponent. Without hesitation, he blocks the kick. Everyone cheers and he proudly grins at me. Will he wish someday we had pursued growth hormone therapy for him? Or will he thank us for letting him grow at his own pace as he accepts a diploma from Harvard. I'll get back to you on that one... in about sixteen years.
-- Brigid Galloway, February 27, 2007
| For more information on short stature in children and growth hormone deficiency, go to www.emedicine.com.
For information on Stephen S. Hall's new book "Size Matters: How Height Affects the Health, Happiness and Success of Boys and the Men They Become" visit www.sizemattersthebook.com.
For more information about the research conducted by The Children's Hospital of Philadelphia and the University of Pennsylvania into the link between elevated growth hormone levels and cancer, go to www.sciencedaily.com.