Pediatricians face clinical and ethical dilemmas about therapy to augment growth in short children who do not meet classic criteria for growth hormone (GH) deficiency. Biologic norms of health are unhelpful because of the uncertain relationship between stature, GH secretion, health, and disease. Instead, we suggest that GH therapy be evaluated from the perspective of cultural norms. We compare GH therapy for short normal children with currently accepted therapies for non--life-threatening pediatric conditions such as well-child care, cosmetic therapy, treatment of psychological problems, and invasive outpatient therapy for chronic conditions. Based on this analysis, we argue that the burdens of therapy, the uncertainty about long-term risks and benefits, the unclear therapeutic end point, and the implications for child health policy place routine GH therapy for children without documented deficiency of GH secretion outside current pediatric ethical norms. Such therapy is properly administered within a comprehensive clinical research protocol.
KIE: Growth hormone therapy for short children who do not meet the classic criteria for growth hormone deficiency should be evaluated from the perspective of cultural values, not biologic norms of health. Physicians can weigh the ethical acceptability of new growth hormone therapies by comparing them with pediatric treatments for non-life-threatening problems, such as preventive well-child care, treatment for psychosocial problems, cosmetic therapy, and invasive outpatient therapy for chronic conditions. An analysis of the risks and benefits of growth hormone therapy and their implications for child health policy suggests that routine growth hormone therapy for children without documented deficiency of growth hormone secretion is properly administered within a comprehensive clinical research protocol and remains outside current pediatric ethical norms.