Misuse of Medical Growth Charts Harms Short Children
The current reference pediatric growth charts, which are used by most pediatric offices, show a representation of the height of children of the same age and gender in the United States. They include clear demarcation lines showing the “normal” range, which is usually represented between the 5th and 95th percentile. The range depicted in these charts is the “statistical normal” distribution based on the standard deviation bell curve of the population of children in the United States (it is not based on a medical assessment of what is considered “normal”). The chart itself is a very simplistic tool that may be an acceptable means to satisfy curiosity for those who do fall within the normal range, but for those who do not, it is more than worthless – it can be quite damaging.
Most parents eagerly anticipate the pediatrician’s arrival in the waiting room so that they can see where the doctor will plot their child’s growth on the chart. They want to see whether their child falls into the “normal” range and which percentile band their child occupies on the curve. What most parents fail to realize is that the standard growth charts do not accurately reflect the true range of normality in the natural variation of the human race. Growth rates vary widely over periods of time, as well as among different nationalities and ethnicities. The charts only show a representation of heights in a given population at a particular point in time; they say nothing about growth rates or other differences that affect height. Yet, many parents whose children fall outside of the “normal” range experience stress and anxiety and, unfortunately, many doctors respond with unnecessary medical testing and intervention.
The doctors’ focus on measuring height and plotting it on growth charts at every medical visit superficially elevates the importance of height in the minds of parents, and fosters heightism in our society, to the detriment of children who happen to be outside of this arbitrary “normal” range. Parents of a short child often begin worrying about all the social problems the child will encounter as a result of being short. They even pursue medical intervention, including growth hormones and sometimes even surgery – anything to avoid their child being fated to remain short. Whether intentionally or subconsciously, this worrying is conveyed to the child. Parents begin to act differently and treat the child differently. The child learns to associate shortness with inadequacy.
Growth charts are less helpful than they are anxiety-producing. They provide little value for those children who are developing within the cultural norm, but they cause worry and guilt on the part of the parents who have short children. Growth charts help make height into an issue that it otherwise would not be.