Self-esteem of kids with short stature tied to social supports, not height

Challenging the assumption that short stature negatively impacts children and adolescents' self-esteem, a new study by researchers at Children's Hospital of Philadelphia (CHOP) has found that in otherwise healthy short youth, quality of life and self-esteem are associated with coping skills and how supported they feel and not the degree of their short stature. The findings were published in The Journal of Pediatrics.

"There is a notion among some parents and caregivers that short stature will negatively impact their children in terms of self-esteem and social adjustment, so they seek out growth hormone treatment in the hopes that making their children taller will make them happier," said senior study author Adda Grimberg, MD, a pediatric endocrinologist and Scientific Director of the Growth Center at CHOP.

"But our data show that self-esteem among short youth is tied to social support networks and adaptive coping strategies, not their stature. Given that adolescence is such a critical period for identity formation, addressing short stature in otherwise healthy children and teens through a broader, psychosocial approach might have a more positive impact on self-esteem than focusing on increasing their height."

Pediatric growth hormone (GH) treatment was initially intended for those with a hormone deficiency, offering metabolic, body composition and cardiovascular health benefits in addition to increased height. However, its use has expanded to those with normal GH production who are short for their age, with the sole aim of augmenting height, based on the premise that short stature is debilitating and that height increases lead to improved quality of life.

However, prior studies have found inconsistent associations between short stature and quality of life. Given the critical gap in understanding how patient and parent characteristics alter the potential impact of being short, 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.

Sixty parent-child pairs were surveyed for the study, either over the phone or in person at or around 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 consistent of 55 females and 5 males, with a mean age of approximately 46. Youth in the study were otherwise 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 average 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 the height of the parents.

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. However, the researchers caution that this potential explanation warrants further investigation in longitudinal research, which is currently underway.

"This study shows that in otherwise healthy children, height isn't a problem unless we frame it as such," Dr. Grimberg said. "Instead, we should focus on bolstering social connections and supports. Being socially integrated in a network of meaningful relationships not only helps children and adolescents cope successfully with life's adversities, but it also encourages them to pursue life opportunities for growth and development."