The use of growth hormone in short normal children remains a controversial issue. Many studies continue to evaluate the benefits of treatment only in terms of the number of centimetres gained.1-3 Before asking who mightrespond to growth hormone, we should first ask who needs it. It is some 13 years since the Wessex growth study (WGS) began and it is appropriate to draw some evidence based conclusions about the normality, or otherwise, of the short normal child.4

Rational intervention assumes some abnormality, physical or psychological, that can be corrected. Where short stature is the result of growth hormone deficiency (GHD), the case for intervention is clear and uncontroversial: final adult height is compromised and the underlying endocrine disorder is associated with a variety of physiological abnormalities. Disorders of mood and performance have also been linked to GHD, especially in adults, but while these may be of interest, a psychological assessment is not required to justify the use of growth hormone.5

In the short but otherwise normal child, the indications for treatment are less clear. Despite the fact that short stature per se is not a disease, two distinct lines of reasoning have nevertheless been proffered in defence of growth hormone therapy for these children, each claiming to demonstrate the abnormality of short stature. First, it has been …