Self-esteem of shorter kids linked to social support, not their height

PHILADELPHIA — It’s a common assumption that shorter adolescents may feel “lesser than” their taller classmates, but new research suggests it isn’t so much about their personal measurements as it is the degree of social support they receive that determines feelings of inadequacy. Researchers from the Children’s Hospital of Philadelphia say their latest work indicates that among healthy short children, quality of life has an association with both coping skills and how well-supported they feel, as opposed to their actual height.

“There is a notion among some parents and caregivers that short stature will negatively impact their children in terms of self-esteem and social adjustment, so they seek out growth hormone treatment in the hopes that making their children taller will make them happier,” says senior study author Adda Grimberg, MD, a pediatric endocrinologist and Scientific Director of the Growth Center at CHOP, in a media release. “But our data show that self-esteem among short youth is tied to social support networks and adaptive coping strategies, not their stature. Given that adolescence is such a critical period for identity formation, addressing short stature in otherwise healthy children and teens through a broader, psychosocial approach might have a more positive impact on self-esteem than focusing on increasing their height.”

Pediatric growth hormone (GH) treatment was originally developed and intended for people with a hormone deficiency, offering metabolic, body composition, and cardiovascular health benefits in addition to increased height. However, its use has expanded in recent years to include those with normal GH production who happen to be short for their age. In such cases, the treatment is used solely to increase height, based on the assumption that being short is debilitating and an increase in height can help improve quality of life.

However, prior studies have already noted numerous inconsistent associations between short stature and life quality. Considering this critical gap between understanding how patient and parent characteristics alter the potential implications of being short, researchers chose to conduct a prospective observational study aimed at assessing self-esteem and quality of life among children between eight and 14 years-old who had been scheduled to undergo provocative GH testing at CHOP between June 2019 and May 2021.

Child measuring how tall he is on height chart
(© Konstantin Yuganov –

In all, the team surveyed 60 parent-child pairs for this project (either in person or over the phone) at or around the time of the appointment. Kids assessed their self-esteem, coping skills, social support networks, and parental support, while parents reported their perceived external threats and achievement goals for their child. Both children and adults reported on the youth’s quality of life. Among surveyed adolescents, 15 were girls and 45 were boys, with the ages breaking down evenly between those who were prepubertal and those who were in early to mid-puberty. The parents, meanwhile, were made up of 55 women and five men (average age 46 years-old). All included children were otherwise healthy.

Next, using statistical models, the research team uncovered that among the children, perceived social support and coping skills displayed a link to quality of life and self-esteem. However, height did not. Perceived social support, especially from friends and classmates, was the factor most consistently associated with how both parents and kids viewed youth self-esteem and quality of life.

Study authors also report a positive association between average parental height and youth self-esteem, with kids born to taller parents reporting higher self-esteem. Researchers speculate this association could be due to several factors. To start, kids born to taller parents may be told their short stature is temporary (considering the height of the parents). Moreover, this finding may be the result of selection bias; short parents who consider their own height as non-problematic may be less likely to seek care for their child’s short stature.

Meanwhile, short parents who are unhappy about their own height may be more motivated to express negative messaging about short stature and seek medical care for their kids. Still, all things considered, the research team cautions this theory warrants further investigation. Luckily, that research is already currently underway.

“This study shows that in otherwise healthy children, height isn’t a problem unless we frame it as such,” Dr. Grimberg concludes. “Instead, we should focus on bolstering social connections and supports. Being socially integrated in a network of meaningful relationships not only helps children and adolescents cope successfully with life’s adversities, but it also encourages them to pursue life opportunities for growth and development.”

The study is published in The Journal of Pediatrics.

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John Anderer

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