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Growth, Stature and Psychosocial Well-Being,
  1. C J H KELNAR, Consultant Paediatric Endocrinologist

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    Growth, Stature and Psychosocial Well-Being, edited by Eiholzer U,et al. (Pp 214, hardback; £24.75.) Gottingen: Hogrefe & Huber Publishers, 1998. ISBN 0 889 37197 0 .

    Copious information about the efficacy of growth promoting treatment for short stature of varying aetiology has been accumulating in recent years. Substantial insights are also developing into whether being taller (if achievable) is necessarily desirable or beneficial.

    In the context of paediatric practice, children are commonly referred for short stature or pubertal delay and often demonstrate (apparently) short stature related psychosocial stress and distress. Is short stature psychologically stressful in itself? Do children with short stature, whether those with underlying pathology or those at an extreme of the normal height distribution, have clinically significant behavioural, emotional, or educational problems? Do children and adolescents with short stature or pubertal delay who are not referred have the same psychological problems as some of those who are? Do the psychological stresses of being short contribute to the development of psychological problems? How do we measure the emotional cost of coping? Does increased growth, in the short or long term, reduce or eliminate the “at risk” psychological status of such children? What are the effects of emotional disorders on growth?

    Some of these questions were addressed and discussed at a symposium in Zürich, Switzerland entitled “Growth and psyche” and this book contains the substance of the papers presented. There are 17 contributions from psychologists, psychiatrists, clinicians, and auxologists from Europe, Scandinavia, and the United States with contributions from a number of well known names in the field. The intention of the symposium was to examine the quality of life of small children, to discuss why results in this area have been contradictory, to develop insights into the problems of psychometric methods, and to examine the effects that psychological factors may have on growth.

    This book reflects the strengths and deficiencies that would be expected given its origin in a symposium, with chapters that are very variable in quality. Two of the best have already been published in virtually identical form in peer review journals. However, there is an outstanding review by Sandberg on the experiences of being short. In contrast, the two chapters in the section “Variation of normal growth patterns and their consequences” are respectively too superficial and out of date (at one point referring to “an excellent review on recent research” dated 1989) and totally unreferenced apart from the author’s own previous review from 1991.

    Helpful insights can be gained from a number of chapters—for example, Lindemann’s comment from an evolutionary perspective that “the power of height stereotypes should not be overemphasized—we are not at the mercy of our evolution and stereotypes are often short lived and narrow.” Some chapters are of particular interest and can be read with profit by anyone involved in this area (including all paediatricians). Nevertheless, the book fails to deliver the “clear overview of the current state of knowledge” promised in the foreword.