TALL STATURE
As long as a child is well and adequately fed, his or her height including
final height is determined almost exclusively by genetic factors. Both
parents have an equal effect on the height of their children which is closely
related to the mid-point between the relative heights of the parents. Since
some children are early and some are late developers the final height cannot
be predicted from the relative height of a child at a given age but, with
the help of a wrist X-ray to show the maturity of the bones, a reasonably
accurate prediction of final height can be made.
Effects:
Fortunately, tall stature is considered desirable in our society and
is statistically linked with high intelligence and even with social success.
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 for many generations so the level at which tall stature is
considered a problem has also increased. However, there are clearly limits
of height beyond which it is difficult to find clothes, and especially
shoes, to fit into cars, theatre seats and so on. Opinions vary on the
limits of acceptable height but in most tall families a height up to 6ft
5in for men and up to 6ft 0in for women is acceptable. If height predictions
are exceeding these limits, it seems reasonable at least to consider treatment
to limit height.
Investigations:
There are some conditions in which growth is increased in childhood,
especially those in which there is also early pubertal development, and
fewer in which the final height is increased. These conditions can usually
be excluded by physical examination and a small number of simple tests
including blood tests and the wrist X-ray.
Management:
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 oestrogens 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 and, beyond a certain degree of bone maturity there
is little to be gained by treatment. Early treatment can limit height by
approximately 2-4in.
Outlook:
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 much the most useful
approach. |
