Evidence-based answer

Yes, treatment can increase a child's final height. Injections of recombinant human growth hormone (rGH) at least 3 times a week for 4 to 6 years add 3.7 to 7.5 cm to final height in children between 8 and 16 years of age with idiopathic short stature (strength of recommendation [SOR]: B, 2 small, low-quality, randomized controlled trials [RCTs]). This population comprises children who are otherwise physically and developmentally normal with a height standard deviation score (SDS) of ≤ -2.0--comparable to the bottom 2.5% percentile of height--and an adequate response to growth hormone stimulation testing.

Clinical commentary

Do we really want to treat healthy short children?

Parents should understand that children who are treated with rGH will still be short, just less short. A young man with a predicted adult height of 63 inches after 5 years will have an adult height of 65 inches--still short by most measures. Clinical trials of rGH for idiopathic short stature have been small and of poor quality, raising the possibility of unforeseen serious adverse outcomes.

Families need to know that insurance rarely covers treatment, which costs $100,000. Treating all of the 400,000 children in the United States with idiopathic short stature would cost $40 billion. Moreover, treating healthy short children with rGH raises questions about the value of height and physical appearance, which are even more difficult to address.

Adam Zolotor, MD

University of North Carolina, Chapel Hill

* Evidence summary

rGH has been available since 1985. The...