Being too short or tall may cause emotional problems in children

Donya Betancourt, Pediatrician, Sanur, Bali, drdonya@hotmail.com

When discussing child growth, one will find the term "tall stature".

Tall stature is a relative term used in referring to any person that is more than two standard deviations above the average height for a person of the same age and sex.

Tallness in children usually presents less initial concern than shortness because, at least in early childhood, being tall is socially advantageous.

Nonetheless, some children who are very tall find this embarrassing and nearly all have some difficulties in childhood related to the confusion about age and maturity which arises when a child is taller than their age group.

There has been a tendency for the average height of men and women to increase over generations so the level at which tall stature is considered a problem has also increased.

Opinions vary on the limits of acceptable height but in most tall families a height up to 6 feet 5 inches (192.5 cm) for men and up to 6 feet (180 cm) for women is acceptable.

If height predictions exceed these limits, it seems reasonable at least to consider treatment to limit height.

What are the causes of tall stature?

The term gigantism refers to a condition of tall stature where an excess of growth hormone occurs in prepubertal children. (Excessive growth hormone in postpubertal children and adults is called acromegaly).

Gigantism is extremely rare. It is associated with enlarged soft tissues and late skeletal growth plate closure. Height may reach 7 feet to 8 feet. Other causes of tall stature include Marfan's syndrome and Sotos' syndrome.

Marfan's syndrome is a condition that causes tall stature and eye and heart abnormalities. Marfan's syndrome is one of the most frequent tall stature syndromes and comprises excessively long limbs, especially arachnodactly (long thin fingers); eye abnormalities (a tendency of subluxation of the lens, myopia and retinal detachment) and cardiovascular problems manifesting in childhood as a valve lesion. The aneurysm (dilated major blood vessels) problems associated with Marfan's syndrome are rarely present in childhood.

Sotos' Syndrome, or cerebral gigantism, usually presents early in childhood. The characteristics are tall stature, large hands and feet, poor circulation and development delay. Bone age is usually advanced and puberty occurs early, therefore, ultimately, these individuals may not be noticeably tall as adults.

These conditions can usually be excluded by physical examination and a small number of simple tests including blood tests and the wrist X-ray.

The most important measure is usually to make a height prediction and reassure the child and family that this is not excessive. If the predicted final height is considered unacceptable, medical treatment is available to accelerate the process of puberty which eventually causes fusion of the growing points in the bones of the limbs and spine.

In girls, it is necessary to give high doses of estrogen and in boys high doses of testosterone. Such treatment also causes early physical development and, it must be remembered, also has an effect on mental functioning and emotional maturity. The earlier such treatment is started, the more effect on limitation of final height it is likely to have. Early treatment can limit height by approximately 2 inches to 4 inches.

Excessively tall stature may, on the other hand, cause problems at school. Firstly, because it is difficult to remember that a five year old who has the stature of an eight year old is actually five. Secondly, because their size is inappropriately large for classroom peers thus tall children may be labeled as clumsy or aggressive and tall stature may cause emotional problems.

Even those children who do find their tall stature a trial throughout childhood generally come to appreciate that it is a positive advantage in adult life. For most tall children, reassurance is the most useful approach.

Being too short or too tall can cause emotional problems or affect children's self-esteem. Reassuring and assisting your child while he or she goes through these problems is always important.