Does Height Equal Happiness for Children?

The findings

Researchers at Children’s Hospital of Philadelphia found that quality of life and self-esteem in healthy short youth are associated with their coping skills and perceived social support — not the degree of their short stature.

Why it matters?

Given that adolescence is such a critical period for identity formation, addressing short stature in healthy children and teens through a broad, psychosocial approach could have a more positive impact on self-esteem than focusing on increasing their height through pediatric growth hormone (GH) treatment.

GH treatment was initially intended for those with a hormone deficiency, offering metabolic, body composition, and cardiovascular health benefits, in addition to increased height. Its use, however, has expanded to children with normal GH production, but who are short for their age.

Some parents and caregivers think that that short stature will negatively impact children in terms of self-esteem and social adjustment, according to pediatric endocrinologist Adda Grimberg, MD, and they seek GH treatment in the hopes that making their children taller will improve their lives.

“What this study says is, ‘No, it’s not the height that makes you happy at the end of the day; it’s your social skills, it’s your social supports, it’s your coping skills.’ And that doesn’t matter what height you are,” Dr. Grimberg said.

Who conducted the study

Dr. Grimberg, scientific director of the Diagnostic and Research Growth Center, and Victoria Miller, PhD, director of research of the Craig-Dalsimer Division of Adolescent Medicine, led the CHOP research team.

How they did it

The researchers conducted a prospective observational study to assess self-esteem and quality of life metrics of children between the ages of 8 and 14 who were scheduled for provocative GH testing at CHOP between June 2019 and May 2021.

They surveyed 60 parent-child pairs for the study, either over the phone or in person at or near the time of the appointment. Youth assessed their self-esteem, coping skills, social support networks, and parental support, while parents reported their perceived external threats and achievement goals for their child. Both reported on the youth’s quality of life.

Among the youth surveyed, 15 were female and 45 were male, and the ages broke down evenly between those who were prepubertal and those who were in early- to mid-puberty. Parents consisted of 55 females and five males, with a mean age of approximately 46. Youth in the study were healthy.

Using statistical models, the researchers found that among children and adolescents in the study, perceived social support and coping skills were associated with quality of life and self-esteem, but youth height was not. Perceived social support, particularly from friends and classmates, was the factor most consistently associated with how both parents and their child viewed youth self-esteem and quality of life.

The researchers also found a positive association between mid-parental height and youth self-esteem, with those with taller parents reporting higher self-esteem. The researchers suggest the association could be due to several factors. First, children of taller parents may be told their short stature is temporary, given their parents’ height. Additionally, this finding could be due to selection bias. Short parents who view their own short stature as non-problematic may be less likely to seek care for their child’s short stature, whereas short parents who are unhappy about their own height may be more inclined to express negative messaging about short stature and seek medical care for their child. The researchers caution that this potential explanation warrants further investigation in longitudinal research, which is currently underway.

Quick thoughts

“It used to be if a child had growth failure, it was deemed important because it could be a clue to an underlying health problem,” Dr. Grimberg said. “People used to come in and say, ‘I want my child to be healthy. Is there something wrong?’ And if they were healthy, the parents were happy. It didn’t matter the height. Some still do that. But now, because growth hormone is out there, more and more people focus on the height itself and that height equals happiness.”

Where is the study published?

The study appeared in The Journal of Pediatrics.

What’s next?

Dr. Grimberg will continue to study short stature and growth hormone therapy and their effect on quality of life and self-esteem. Her desired outcome for this research is to “go retro” and once again look at growth as a vital sign of child health.

“I want to get our mindset back to the health piece as the priority,” Dr. Grimberg said. “And if you’re short and you’re healthy and you still want growth hormone to make you taller, fine, but that’s a different conversation. That should be the secondary conversation and not what’s driving the ship.”