Growth attenuation therapy: practice and perspectives of paediatric endocrinologists

Growth attenuation therapy for children with severe physical and cognitive disability: Practice and perspectives of New Zealand paediatricians

“…There are currently no legal or clinical guidelines for GAT in NZ, and controversy surrounding GAT remains, involving issues of disability rights, parental autonomy and the best interests of the child . Different countries and even different clinicians take different approaches to managing the tension between the differing viewpoints on GAT . In Australia, it has been suggested that GAT is not legal unless a court order authorising the violation of a child's bodily integrity as part of non‐therapeutic treatment is granted .…”

“…A survey was then developed using SurveyMonkey (Palo Alto, CA, USA). This survey was based on and extended from one used in an American study surveying paediatric endocrinologists on their attitudes and practices regarding GAT . Potential participants in the current study were approached via email between November 2016 and January 2017.…”

“…3 Subsequently a small number of parents in New Zealand (NZ; precise numbers unknown) and worldwide (>100) have pursued similar treatment to allow them to continue to provide long-term care for their children at home rather than institutional care. [4][5][6] Despite these perceived advantages, there is considerable ethical controversy regarding GAT, with opposition from advocates for the rights of people with disability and some health professionals. 3,7 Contentious issues involved with GAT include: determining what is best for individual disabled children; the extent to which parents, doctors or even courts are entitled to make these decisions; and the threshold of cognitive and physical disability that might qualify a child for GAT; some sources have recommended that GAT should only be considered for children with severe cognitive and physical disability.…”

“…This survey was based on and extended from one used in an American study surveying paediatric endocrinologists on their attitudes and practices regarding GAT. 5 Potential participants in the current study were approached via email between November 2016 and January 2017. Email invitations included a brief overview of the study and its purpose and a link to a Sur-veyMonkey internet-based survey for those consenting to proceed.…”

“…The intention behind the parents’ controversial decision to pursue GAT for their daughter was to improve her quality of life by causing her to remain a size at which family activities remained possible . Subsequently a small number of parents in New Zealand (NZ; precise numbers unknown) and worldwide (>100) have pursued similar treatment to allow them to continue to provide long‐term care for their children at home rather than institutional care …”