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Re: Re: Short Stature, school grade and growth monitoring

Dear Editor,

We read with interest the paper by Wake, et al [1] which highlights the relation between child's height and grade progression in primary school. The authors reported that the group of boys who had repeated a grade, who were relatively short for their age, appeared to be responsible for this relation. Children with short stature may experience academic difficulties, psychological impairment, and emotional stress related to an underlying medical condition or social stigmatization.[2,3] However, there are some limitations of the study. One of the limitations is that all short children were included despite heterogeneous nature of short stature. We didn't see any exclusion criteria such as children with growth hormone deficiency, Turner's syndrome or chronic disease (ie, diabetes mellitus, chronic renal failure) or dysmorphic syndrome resulting short stature. All these conditions have an additional deleterious effect on psychosocial function and academic achievement of children.[2] Besides birth weight, sociodemographic influences and ethnic background included in the study, a lot of other factors (ie environmental, poverty, nutrition, anemia, lead intoxication, presence of vision and hearing problems, chronic disease, usage of any medication) can affect academic achievement. Thus, in order to make a decision about children with school failure, the conditions affecting academic achievement should be excluded or examined by multi-factorial analysis. Additionally, the authors failed to explain why short stature only affected the boys in the fifth grade. We think that some children in the fifth grade may have already had a growth spurt which would affect the self-esteem and emotional status of short children. If the authors could explain these limitations, the article would have a greater value. Further studies in short adolescents which have already had growth spurts could make clear gender differences in school achievement and could test the hypothesis of this study that short boys are disadvantaged.

The article shows that growth monitoring is an important part of school health supervision. The major role of growth monitoring is to focus the attention of health workers on the promotion of adequate growth. A growth chart, which can be easily followed in school, is of the greatest value in terms of preventive action as it shows any growth problem.[4] The diagnosis of children with growth retardation must be done at an early school age. Educational and psychosocial problems associated with short stature can be alleviated with appropriate case management. Paediatricians, family physicians, teachers, and parents should be aware of the potential academic, psychological, and social problems related to short stature. In this way, short children can be supported and optimum growth can be achieved. Therefore, a multidisciplinary management approach for short children in school could allow diagnosis and the appropriate treatment of conditions resulting in growth retardation, the early detection of problems in academic achievement and psychosocial development in cases of short stature. The appropriate educational and counselling interventions could then be provided.

S Songül Yalçin

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