Parental Concerns on Short Stature: A 15-Year Follow-Up

Abstract

Objectives: To compare parental attitudes about short stature over time and determine possible factors that predict changes in attitudes.

Study design: At baseline (1993-1994), we surveyed parents about their attitudes regarding their children's height. We compared parents of children (aged 4-15 years) referred to endocrinologists (referred, 154) with those of children with heights <10th percentile seen by pediatricians during regular visits (control, 240). At follow-up (2008-2009), 103 control and 98 referred parents completed a similar survey. We then made a logistic regression analysis to observe changes in perception. Primary variables included self-esteem, treatment by peers, and ability to cope with current height.

Results: At baseline, referred parents perceived a worse impact of short stature on their children than did controls. At follow-up, instead, referred parents were 3.8 times more likely to report improvement in self-esteem, 2.4 times more likely to report improved treatment from peers, and 5.7 times more likely to report overall ability to cope with height than were unreferred parents. Perception of psychosocial improvement was greater in the referred than the control group. Referral was a stronger predictor of an improved follow-up response than patients' current height or change in height.

Conclusions: While incorporating parental attitudes into management decisions, clinicians should be aware that parental perceptions may change over time and that referral itself may lead parents to perceive psychosocial improvements over time.

Keywords: ethics; growth hormone; short stature.

Figure 1.

At baseline, parental perception of the impact of short stature on their children was worse in the referred group than in the control group. This figure shows the mean values for 3 of the 14 questions asked (self-esteem, treatment by teachers, and overall ability to cope with current height).

Figure 2.

At follow-up, both groups reported improvement in outcome in the same questions as the original studies. Parents of referred patients were significantly more likely to perceive improvement than were controls.

Figure 3.

Factors predicting change in parental attitudes from baseline to follow-up: Logistic regression. Improvement was associated with referral to endocrinologists in all questions. Male sex was predictive of improved self esteem and perception of treatment from peers. Growth and current height (SD) were predictive of improved ability to cope.