Aims: To examine parental concerns about child growth and factors that drive parents' decisions whether to intervene medically with their child's height. Methods: Parents of 9- to 14-year-old pediatric primary care patients of various heights, oversampled for those with short stature, participated in exploratory focus groups and nominal group technique sessions. Growth concerns expressed by the groups were incorporated into a survey, completed by 1,820 parents, and rated for their degree of impact on medical decision-making. Ordinal logistic regression modeled concern scores against parent traits. Explanatory focus groups clarified the survey results. Results: Research team consensus and factor analysis organized the 22 distinct concerns expressed by the parent groups into 7 categories. Categories rated as having the greatest influence on parental decision-making involved: treatment efficacy and side effects, child health and psychosocial function. Level of concern was highly associated with parental education and parenting style. Conclusion: Psychosocial issues are influential, but parental decision-making is most impacted by concerns about treatment and child health. By discussing the real risks and benefits of hormone treatment and addressing parents' perceptions of what is needed for physical and psychosocial health, clinicians can be highly effective educators to assure that treatment is used only as medically indicated.

1.
Oostdijk W, Grote FK, de Muinck Keizer-Schrama SM, Wit JM: Diagnostic approach in children with short stature. Horm Res 2009;72:206-217.
2.
Craig D, Fayter D, Stirk L, Crott R: Growth monitoring for short stature: update of a systematic review and economic model. Health Technol Assess 2011;15:iii-iv, 1-64.
3.
Sisley S, Trujillo MV, Khoury J, Backeljauw P: Low incidence of pathology detection and high cost of screening in the evaluation of asymptomatic short children. J Pediatr 2013;163:1045-1051.
4.
Grimberg A, Feemster KA, Pati S, Ramos M, Grundmeier R, Cucchiara AJ, Stallings VA: Medically underserved girls receive less evaluation for short stature. Pediatrics 2011;127:696-702.
5.
Grimberg A, Kutikov JK, Cucchiara AJ: Sex differences in patients referred for evaluation of poor growth. J Pediatr 2005;146:212-216.
6.
Grimberg A, Stewart E, Wajnrajch MP: Gender of pediatric recombinant human growth hormone recipients in the United States and globally. J Clin Endocrinol Metab 2008;93:2050-2056.
7.
Cuttler L, Marinova D, Mercer MB, Connors A, Meehan R, Silvers JB: Patient, physician, and consumer drivers: referrals for short stature and access to specialty drugs. Med Care 2009;47:858-865.
8.
Silvers JB, Marinova D, Mercer MB, Connors A, Cuttler L: A national study of physician recommendations to initiate and discontinue growth hormone for short stature. Pediatrics 2010;126:468-476.
9.
Hardin DS, Woo J, Butsch R, Huett B: Current prescribing practices and opinions about growth hormone therapy: results of a nationwide survey of paediatric endocrinologists. Clin Endocrinol (Oxf) 2007;66:85-94.
10.
Finkelstein BS, Singh J, Silvers JB, Marrero U, Neuhauser D, Cuttler L: Patient attitudes and preferences regarding treatment: GH therapy for childhood short stature. Horm Res 1999;51(suppl 1):67-72.
11.
Singh J, Cuttler L, Shin M, Silvers JB, Neuhauser D: Medical decision-making and the patient: understanding preference patterns for growth hormone therapy using conjoint analysis. Med Care 1998;36(suppl):AS31-AS45.
12.
Ginsburg KR, Alexander PM, Hunt J, Sullivan M, Zhao H, Cnaan A: Enhancing their likelihood for a positive future: the perspective of inner-city youth. Pediatrics 2002;109:1136-1142.
13.
Ginsburg KR, Slap GB, Cnaan A, Forke CM, Balsley CM, Rouselle DM: Adolescents' perceptions of factors affecting their decisions to seek health care. JAMA 1995;273:1913-1918.
14.
Ginsburg KR, Howe CJ, Jawad AF, Buzby M, Ayala JM, Tuttle A, Murphy K: Parents' perceptions of factors that affect successful diabetes management for their children. Pediatrics 2005;116:1095-1104.
15.
Cousounis PA, Lipman TH, Ginsburg K, Cucchiara AJ, Grimberg A: How short is too short according to parents of primary care patients. Endocr Pract 2014;20:1113-1121.
16.
Hood B, Power T, Hill L: Children's appraisal of moderately stressful situations. Int J Behav Dev 2009;33:167-177.
17.
Slater MA, Power TG: Multidimensional assessment of parenting in single-parent families; in Vincent JP (ed): Advances in Family Intervention, Assessment, and Theory, ed 4. Greenwich, JAI, 1987, p 197.
18.
Baumrind D: Effects of authoritative parental control on child behavior. Child Dev 1966;37:887-907.
19.
Maccoby E, Martin J: Socialization in the context of the family: parent-child interaction? in Hetherington EM (ed): Handbook of Child Psychology, ed 4. New York, Wiley, 1983.
20.
Institute of Medicine; Committee on Quality of Health Care in America: Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, National Academies Press, 2001.
21.
Maizes V, Rakel D, Niemiec C: Integrative medicine and patient-centered care. Explore (NY) 2009;5:277-289.
22.
Lanes R: Metabolic abnormalities in growth hormone deficiency. Pediatr Endocrinol Rev 2004;2:209-215.
23.
Allen DB: Safety of growth hormone treatment of children with idiopathic short stature: the US experience. Horm Res Paediatr 2011;76(suppl 3):45-47.
24.
Carel JC, Ecosse E, Landier F, Meguellati-Hakkas D, Kaguelidou F, Rey G, Coste J: Long-term mortality after recombinant growth hormone treatment for isolated growth hormone deficiency or childhood short stature: preliminary report of the French SAGhE study. J Clin Endocrinol Metab 2012;97:416-425.
25.
Sävendahl L, Maes M, Albertsson-Wikland K, Borgström B, Carel JC, Henrard S, Speybroeck N, Thomas M, Zandwijken G, Hokken-Koelega A: Long-term mortality and causes of death in isolated GHD, ISS, and SGA patients treated with recombinant growth hormone during childhood in Belgium, the Netherlands, and Sweden: preliminary report of 3 countries participating in the EU SAGhE study. J Clin Endocrinol Metab 2012;97:E213-E217.
26.
Poidvin A, Touzé E, Ecosse E, Landier F, Béjot Y, Giroud M, Rothwell PM, Carel JC, Coste J: Growth hormone treatment for childhood short stature and risk of stroke in early adulthood. Neurology 2014;83:780-786.
27.
Cousounis P, Lipman TH, Ginsburg KR, Grimberg A: Internet informs parents about growth hormone. Horm Res Paediatr 2013;80:86-91.
28.
Deaton A, Arora R: Life at the top: the benefits of height. Econ Hum Biol 2009;7:133-136.
29.
Hall SS: Size Matters: How Height Affects the Health, Happiness, and Success of Boys - and the Men They Become. Boston, Houghton Mifflin, 2006.
30.
Stulp G, Mills M, Pollet TV, Barrett L: Non-linear associations between stature and mate choice characteristics for American men and their spouses. Am J Hum Biol 2014;26:530-537.
31.
Judge TA, Cable DM: The effect of physical height on workplace success and income: preliminary test of a theoretical model. J Appl Psychol 2004;89:428-441.
32.
Hensley WE: Height as a measure of success in academe. Psychol J Hum Behav 1993;30:40-46.
33.
Tuvemo T, Jonsson B, Persson I: Intellectual and physical performance and morbidity in relation to height in a cohort of 18-year-old Swedish conscripts. Horm Res 1999;52:186-191.
34.
Lee JM, Appugliese D, Coleman SM, Kaciroti N, Corwyn RF, Bradley RH, Sandberg DE, Lumeng JC: Short stature in population-based cohort: social, emotional, and behavioral functioning. Pediatrics 2009;124:903-910.
35.
Bullinger M, Kołtowska-Häggström M, Sandberg D, Chaplin J, Wollmann H, Noeker M, Brütt AL: Health-related quality of life of children and adolescents with growth hormone deficiency or idiopathic short stature - part 2: available results and future directions. Horm Res 2009;72:74-81.
36.
Allen DB, Cuttler L: Clinical practice. Short stature in childhood - challenges and choices. N Engl J Med 2013;368:1220-1228.
37.
Bolt LL, Mul D: Growth hormone in short children: beyond medicine? Acta Paediatr 2001;90:69-73.
38.
Sandberg DE, Colsman M: Growth hormone treatment of short stature: status of the quality of life rationale. Horm Res 2005;63:275-283.
39.
Grimberg A, Huerta-Saenz L, Grundmeier R, Ramos MJ, Pati S, Cucchiara AJ, Stallings VA: Gender bias in US pediatric growth hormone treatment. Sci Rep 2015;5:11099.
40.
Say R, Murtagh M, Thomson R: Patients' preference for involvement in medical decision making: a narrative review. Patient Educ Couns 2006;60:102-114.
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