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Objective Height is a physical trait on a continuum. The threshold between normal and abnormal is arbitrarily set, potentially influencing medical decision-making. We sought to examine parents’ perceptions of adult heights and associated demographic factors. Methods Parents of pediatric primary care patients of various heights completed a one-time survey. Parents answered, “How short is too short?” for adult males and females. Results were summarized as median [interquartile range]. Factors significantly associated with height threshold by simple linear regression were included in a multivariable mixed effects analysis of covariance model. Results 1820 surveys were completed (83% response rate; 1587 female, 231 male). Median threshold height deemed too short for adult females was 56 inches [48, 59] among male respondents and 57 inches [50, 60] among female (p<.05). Median threshold height for adult males was 61 inches among males [60, 64] and females [59, 66] (p<.05). The median of male minus female heights per respondent (delta heights) was 5 [2, 7] inches. Factors found to be significant main effects in a parsimonious model were sex of adult considered, height of respondent, sex of respondent, respondent race, primary care practice, income and having concerns about their child's height. Conclusion Taller acceptable height thresholds were perceived by respondents who were taller, wealthier, white, female, from non-urban practices or who had a personal concern about their child's height. Male heights were expected to be taller than female. Such traits may influence who is concerned and more likely to seek medical treatment for their children.

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.

<b><i>Introduction:</i></b> Parents (PP) of children in primary care clinics previously reported factors influencing their height-related medical decision making. However, patients seeking height-related care in endocrine subspecialty clinics and their parents (EP) differ demographically from the general population. <b><i>Objective:</i></b> To determine EP height-related medical concerns and expectations, and to compare between EP and PP. <b><i>Methods:</i></b> EP completed a survey assessing their concerns in seeking medical care for their child’s height with identical questions previously asked of PP and two additional questions about growth hormone (GH) treatment. <b><i>Results:</i></b> A greater proportion of the 166 EP (80% response rate) than the 1,820 PP (83% response rate) previously surveyed was Caucasian (75% EP, 41% PP) and privately insured (80% EP, 58% PP). Both groups rated treatment efficacy and risks most as having a <i>big</i>or<i> extreme impact</i> on decision making (65% EP, 58% PP). The second most rated concern for EP was comparison of child’s height to peers or growth chart (60% EP, 32% PP) versus child’s health for PP (54% EP, 56% PP). Of the 166 EP surveyed, 76% rated GH treatment as potentially improving quality of life (QoL), with 88% reporting a minimum 3-inch height increase as necessary to improve QoL. <b><i>Conclusions:</i></b> Height comparisons were more likely to impact EP than PP in seeking height-related medical care for their children. EP had high expectations of QoL improvement with GH treatment, which are unlikely to be met with treatment of idiopathic short stature. Thus, clinicians should be prepared to support families in other ways that promote positive development in children with short stature.

Background: Parents' knowledge influences decisions regarding medical care for their children. Methods: Parents of pediatric primary care patients aged 9-14 years, irrespective of height, participated in open focus groups (OFGs). Moderators asked the question, ‘How do people find out about growth hormone (GH)?' Because many parents cited the Internet, the top 10 results from the Google searches of ‘growth hormone children' and ‘parents of children who take growth hormone' were examined. Three investigators independently performed content analysis and then reached a consensus. The results were tabulated via summary statistics. Results: Eighteen websites were reviewed, most with the purpose of education (56%) and many funded by commercial sources (44%). GH treatment information varied, with 33% of the sites containing content only about US FDA-approved indications. Fifty-six percent of the sites included information about psychosocial benefits from treatment, with 44% acknowledging them as controversial. Although important to OFG participants, risks and costs were each omitted from 39% of the websites. Conclusion: Parents often turn to the Internet for GH-related information for their children, although its content may be incomplete and/or biased. Clinicians may want to provide parents with tools for critically evaluating Internet-based information, a list of prereviewed websites, or their own educational materials.

Primary care providers are charged with distinguishing children with an underlying growth problem from those with healthy variant short stature. Knowing the heights of the biological parents aids in making that decision. This study sought to determine the feasibility and functionality of an electronic mid-parental height (MPH) auto-calculator in the clinical assessment of child growth in a pediatric primary care setting. Clinicians completed surveys for 62% of 6803 children (mean height 13 ± 7 percentile) with recorded parent heights. Collecting parent height data required <30 seconds in 91% of encounters. The MPH tool confirmed clinicians’ initial growth assessment in 79% of cases and changed it in 4%; the remainder did not use the tool. Clinicians who changed assessment were more likely (P < .0001) to pursue more comprehensive evaluation. The MPH tool was a quick, functional resource as a component of an electronic health record system in actual, busy, pediatric primary care practices.