To Stop or Not to Stop	back to Articles
Written by Phil Heinricy · First published in 6ft+ magazine

Lately, we have been getting quite a few calls at HQ from parents thinking about height restriction for their children. The usual themes keep appearing, so perhaps it is time once again for us to look at this particular subject.

Let us first draw the distinction between height reduction and height restriction. The first is a procedure carried out after growth has been completed, to reduce the actual height of the individual, whilst the latter seeks to prevent a pre-pubertal child from reaching its full potential or predicted height.

Height prediction has always been a wildly inaccurate affair, despite the assurances of doctors. Most predictions are given with a margin for error of around plus or minus three to four inches. Satellites and computers can now map an entire country with greater accuracy than that! The common methods used in prediction are:

Bone Age: an X-ray is taken of the child's hand, and from the condition of the bones the physician can make an educated guess as to what stage of maturity the child has reached when compared to the child's actual age. This method has been relied upon for many years, but has proven unreliable in cases where the child has been affected by a height related medical condition, such as Marfan syndrome, in which the child is likely to start puberty at the early end of the age range, and is thus going to stop growing sooner than might have otherwise been expected.

Mid-Parental Height: a simple one this, in which one simply adds the heights of the parents together, divides by two, and then assumes that a boy will end up approximately four inches taller than that figure, while a girl is likely to be around that figure. The margin for error usually allowed is plus or minus four inches for a boy and three inches for a girl. The spanner in the works is that if a family has a history of an autosomal dominant height related disorder (a genetic condition which has a fifty percent chance of being passed on to the next generation), the margin for error has to be increased, as the height element has been known to skip a generation.

Double the Height: keeping an accurate record of your child's growth during its early life will help with this method. Take the height of your child at the age of two years three months for a girl or two years eight months for a boy, and double it. You are likely to be within a couple of inches of the final height the child is going to attain. Even this method has been shown to be increasingly unreliable, as children now go through puberty much earlier than they did even twenty years ago, and so is more likely to result in an over-estimate than an under-estimate.

Methods of Height Restriction

There are three principal methods of restricting the final height a child might achieve, and all of them depend on the treatment being started at or before puberty. Two of these methods are pharmaceutical, one is mechanical. There are recorded cases in which drug treatments were begun too late, resulting in the child becoming even taller than it would have done had it been left untreated.

Artificial Advancement of Puberty

By administering quantities of the appropriate sex hormone to trigger puberty, the pubertal growth spurt is also triggered ahead of time. Parents often panic when shortly after starting the treatment the child heads north at an alarming rate, contrary to their expectations. This is perfectly normal, as it is the pubertal growth spurt, brought on early, exactly as intended. Because the growth spurt also ends earlier than would have been the case without treatment the child's terminal height is reduced.

The advantage of this method is that it has been in use with generally satisfactory results for some time, and its effects are reasonably well understood. The disadvantages are not so well documented, nor do many doctors tell the parents exactly what the long term implications might be.

First, and most importantly, high levels of sex hormone in women has been linked with a higher incidence of cervical and other gynaecological cancers. Second, it has been reported that in approximately 10% of cases in which high levels of sex hormone have been identified, the women have become infertile. These points must be discussed with the doctor, and cannot be ignored when making the decision to begin growth restriction treatment.

In addition, one must also consider that the child is effectively being pushed into puberty at a time when it is unlikely to be psychologically ready to deal with it. A ten year old girl suddenly blossoming into full womanhood may not be what you want for your daughter, while a fourteen year old boy resplendent with beard growth and deep voice finds it much easier to get served in pubs. Along with the sudden physical development comes all the joy and happiness associated with having a teenager in the house, the mood swings, temper displays, and the generally obnoxious behaviour most of us have either been through ourselves, or remember from our dark and distant past. Imagine facing an angry and aggressive fourteen year old who has the body and musculature of a young man, but not the maturity to recognise what is happening and why.

Inhibition of Growth Hormone Production

It is important to note that, as far as we have been able to ascertain, the drug used to achieve a reduction in growth hormone levels has not yet been licensed in this country. Somatostatin has been on trial at Cobbold Laboratories, at the Middlesex Hospital in London with excellent results, but is unlikely to become widely available for some time.

Somatostatin works by suppressing growth hormone production in the pituitary gland. Naturally, with lower levels of the hormone being produced, the final height of the individual is also held in check.

To date, there is some evidence that the main side effect is minor liver damage, however, the drug has not been in use for a sufficient period for the evidence to be conclusive.

Leg 'Stapling'

More common in the USA than in the UK, a pin or staple is inserted into the long bones of the leg, in order to encourage the ends to fuse. The amount of height restriction would appear to be slightly less than with an appropriately timed drug intervention, but the time at which the treatment may be commenced is a little less critical.

Few people have reported major side effects with this method, although one has to take into account that the bones are being deliberately damaged, albeit minor damage, which may produce effects in the event of severe injury, or later in life as the body ages.

Should We? Shouldn't We?

This is the most difficult question of all. There is no doubt that in some cases treatment is wholly appropriate, especially when the child is expected to reach an extreme height as a result of a medical condition. The human body is not designed to be infinitely tall. Muscles, joints, and circulation have limits as to what they can reasonably deal with, and growth restriction might be necessary rather than just desirable. The following paragraphs are intended to deal with routine cases of cosmetic and psychological height restriction, and will not necessarily apply to those who have a medical condition.

Most growth clinics have reported a drop in the number of cases presenting for restriction in the last decade, as people are becoming more aware of how the population generally has increased significantly in height this century. The motivation to restrict a child's height for no more than cosmetic or psychological reasons is not as strong as it once was.

If you are considering growth restriction for your child, you need to ask yourself why. Is it because you are fairly tall and had difficulty adjusting to that fact? Did you not have the support of other all family members to help you to deal with being a little out of the ordinary? Are you now transferring your anxieties on to your child? It is important that you are honest with yourself in answering these questions, because even if you have your child treated it won't, for the most part, change their lives to any vast extent. Let me say that again: you aren't going to make much difference by having your child's growth restricted.

Can that be true? Think about it: if a boy is heading for 6ft 10in, and the treatment stops him at around 6ft 6in or so, he will still be tall by most standards, he will still have trouble getting clothes and footwear to fit, the jokes will still be made, legroom will still be at a premium wherever he goes, beds will be too short, and desks too low. The same applies to a girl who might have been 6ft 2in, and has been stopped at 5ft 11in. So would the treatment be totally pointless? Not necessarily; life will be a little easier, but probably not noticeably so.

What happens to the next generation? If your child has had its growth restricted by a few inches, it will make no difference to its genes, which will still be carrying, and will pass on, the gene for the unrestricted height. Do you want your grandchildren to be treated, and their children, too? Think also about the attitude you are teaching your child: they are receiving medicine to stop them being "too tall", therefore to be tall is to be sick, because only sick people take medicine. Simplistic? Yes, but that's how children think, and that which they learn in childhood they will often carry with them to their graves. A saying which has been credited to many people and organisations is: "Give me the boy until he is seven, and I will give you the man". It applies here as much as anywhere.

Talking of the next generation, we are all aware of how people are still becoming taller, so although you might have been tall twenty years ago, by the time your children reach adulthood they may well no longer be considered as unusually tall. Far better, then, to support them with the knowledge, experience, and understanding you have gained over the years by being tall yourself, and to help them to build the self-confidence which will make the difference between them being a tall person or a person who just happens to be tall.Talking of the next generation, we are all aware of how people are still becoming taller, so although you might have been tall twenty years ago, by the time your children reach adulthood they may well no longer be considered as unusually tall. Far better, then, to support them with the knowledge, experience, and understanding you have gained over the years by being tall yourself, and to help them to build the self-confidence which will make the difference between them being a tall person or a person who just happens to be tall.

On a grander scale, think about all the other tall people in this world. Most will simply live with and adjust to their height and, in many cases, learn to love it, and to capitalise on it. In advocating treatment you are saying to the retailers, designers, manufacturers, and standards setting bodies of this world, "Don't worry about making things fit the people, we'll make our children fit your products. Dumb, or what?

Do We, or Don't We?

You've made your decision, and think it's a good idea to have your child's height restricted. What now? Off to the doctor for a referral to a growth clinic? First things first: talk to your child as openly and as impartially as you can about what you propose. You may be surprised at how even an eight or nine year old child can reach an informed decision, as long as you do give them all the information, without trying to bias them to your way of thinking. Don't be tempted to think that they are only children, and that they won't understand. They can and they will, and they will respect you for consulting them.

It cannot be stressed strongly enough how important it is to involve your child in the decision making process. Many tall people who have had the treatment have commented how it was imposed upon them and how, given the choice, they would have been happy to have been left alone, and not been treated. Some, or course, are happy with the decision made by their parents, but are already thinking about whether they are going to have their own child's height restricted.

Whatever decision you eventually reach between you, make sure that you reach it in good time, i.e. before puberty starts. It is too late when your offspring is singing baritone in the church choir, or is off to university; an eighteenth birthday present it ain't!

If you opt for growth restriction for your child, make sure it is for the right reasons, what is best for them, and not to exorcise your troubled childhood ghosts. Talk to other tall people, parents of tall children - Little Big Ones is a great source of info among parents of tall children, especially if the parents aren't tall themselves - talk to tall children about their feelings, and then make your decision. Be aware that the treatment is not reversible. Once you go with it, there is no turning back.

Above all remember that the height restriction you may decide upon is not for your benefit, but for that of your child. Restricting a child's height can be the right thing to do, but it has to be for the right reasons.

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