Growth delay affects not only the biologic development of a child, but is also typically associated with significant psychosocial and educational problems. Stabler and colleagues review the psychosocial and educational aspects of growth hormone deficiency in children and present a comprehensive approach to the management of children with this disorder.
Children with growth hormone deficiency are considered to be at risk of developmental stress psychologically, educationally and socially. The social behavior of children with growth hormone deficiency has been frequently described as immature, reflecting low self-esteem and depression. Their problem solving abilities are often less than their peers. Twenty to 40 percent of children with growth hormone deficiency are held back at least one grade in elementary school, compared with 4 to 5 percent of normal children. Children with growth hormone deficiency are at risk for marked academic deficiencies and behavioral problems, and require a more specific education prescription than simply repeating a school year.
Treatment of growth hormone deficiency should include recognition of the social, psychologic and educational issues commonly faced by the patients. Ideally, a multidisciplinary team of health professionals should perform a comprehensive evaluation of intelligence, academic achievement and general psychologic function. The primary care physician should explain the medical condition, treatment protocol and prognosis to the patient and parents while providing anticipatory guidance. Important strategies include carefully explaining the medical condition and helping the family to maintain realistic treatment expectations. Pharmacologic treatment consists of long-term growth hormone replacement therapy.
The treatment focus should not be limited to adding additional inches in height. A specific final height should not be guaranteed. Rather, treatment goals should be to increase growth velocity, to keep the child's stature from becoming even more discrepant from peers and to address the psychologic vulnerability of these children.
The etiology of the short stature should be discussed with the parents and child so that misinformation or guilt can be confronted. Concerns about the long-term side effects of medication and methods to facilitate compliance should be specifically addressed. To reduce apprehension about injections of growth hormone, various methods to reduce the pain of injection should be discussed. Readiness for school entry, discussion of the pros and cons of grade retention, comprehensive psychometric assessment by a pediatric psychologist and family counseling may also be useful.
Parents should be encouraged to treat their child according to chronologic age, to discourage and prohibit the use of pejorative nicknames associated with short stature and to encourage participation in sports, such as swimming or skiing, which are not dependent on size. Referral to support organizations, such as the Human Growth Foundation, may also be valuable. (Clinical Pediatrics, March 1991, vol. 30, p. 156.)
COPYRIGHT 1991 American Academy of Family Physicians
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