Wednesday, April 30, 2014

Short stuff

I can't stop thinking about an unpleasant encounter I had yesterday in my clinic. I try really hard to put visits like this behind me, but this one really struck a chord with me. Yesterday, a 2 year old was on my schedule with "growth concerns". I found it odd, since I had just seen him and his 5 year old sibling a few weeks earlier for physicals. They were new patients to me and to my clinic, but were healthy children and the visits were uneventful. I made a plan with the mother to see the 2 year old in 6 months for another check up.

Prior to entering the exam room, I reviewed the growth chart. Everything looked normal, and the child was growing appropriately. When I entered the room, the mother explained to me that the child's father was concerned about his size. When the father entered the room, he basically took control of the visit.

Maurice Jones Drew, 5'7 former running back for the Jacksonville Jaguars; now with the Oakland Raiders
"He's small and I'm concerned about that", he said, talking about his 2 year old son. He went on to tell me that he knows how small boys have problems and he wanted a workup done to make sure there was nothing wrong with his son. After all, he pointed out to me, he himself was 6'1 and their mother was 5'7. He felt that it was not be possible for him to have a small son. He also told me that he wanted his boys to be athletes, and short men just aren't good athletes. He compared this boy to his older son, who is big for his age. He just didn't understand why his younger son wasn't growing like his older brother. Another concern was that his son is a picky eater. He wanted to know what he could do to maximize his son's growth; to make sure he reaches his "full potential". He wanted to know about growth hormone.

I don't know how I kept self control during this visit. I think part of me was so shocked that words like this would even come out of a person's mouth. And believe me, I hear it all, and it takes a lot to shock me. I looked at his adorable 2 year old son with the big blue eyes who was running around the room while we talked.

But what I did was put on my clinician hat. Reviewed the growth chart and showed him his son's linear progression along his percentile curve. Talked about normal eating habits of 2 year olds. Talked about differing growth patterns of siblings. But this dad was having none of that. So reluctantly, I ordered an xray to evaluate bone age and gave him a referral to an endocrinologist. I did all this, even though there would be no work up, no intervention in a 2 year old child. It is simply too early to predict what this child's growth would be. I told the dad this. He still wanted to proceed with the work up.

I thought a lot about this on my drive home. This visit troubled me so much. I try not to personalize encounters like this, but I couldn't help but think about my 2 sons. One, who is tall and lanky, the other who is short and still growing, but probably won't be taller than 5'8, if I could predict...who has the heart of an athlete and gives his all in every sport he plays. He has a great self esteem in spite of being smaller than most of his peers and is extremely well liked (a little too well liked, he needs to focus on his school work more than his social life!). But he's happy and well adjusted. This conversation with that father made my heart hurt for my son.

This is my son, #80, tackling, in a game last fall.
And I thought a lot about all the runners I see on the road when I run races. The last race I ran, the 10 miler, a woman who probably was 4'6--almost a foot shorter than me-- kept pace with me most of the race. When I ran Chicago, people who were twice my size were passing me! My husband always expresses amazement at all the runners who "don't look like runners" but sure can move. There's no denying size matters to a certain extent, but it isn't the only factor affecting athletic ability! Athletes come in all shapes and sizes.

And how many of us or our kids, are going to be good enough to play professional sports? What about participating in a sport for the camaraderie, the physical benefits, the confidence... taking pride in personal achievements? Being the best that we can be?

I took a leap and asked this dad what he would do if his son turned out to be small? I told him basically "you get what you get" when it comes to your genetic makeup. That it would be important to have self confidence and self esteem.

"Oh, of course", he said. And asked me where the endocrinologist's office was located.


  1. Oh geez. This is so disturbing. Good Lord the boy is 2! I am frustrated with you on this one.

  2. I don't have kids, but have a lot of friends who do, so I often think about all the percentile comparisons they talk about, and how much they seem to be pressured to be in a panic about their child's progress (from friends/docs/etc.). I always think... can't we just let these kids grow and see how they turn out? I mean, I know there are things to watch for, but yeah, this 2 yr old sounds totally normal and I hope his dad isn't, I hate to say it, disappointed in him. I am much different than my sister, and I don't care!

    And funny you mention how runners all look different - I was just telling a friend last week that someone I know seemed shocked I could run the paces I could, because of my weight. Gimme a break!

    1. That's my point. You get what you get, and you make the best of your abilities.

  3. Coming from a very short (and VERY athletic) family, I'm reminded of a saying of my dad's that's similar to the one you ended your post with, "It's not the size of the dog in the fight, but the size of the fight in the dog." That's definitely what got me through days of running and soccer when I was *literally* a head shorter than my opponents- the thought that size doesn't matter, heart does.
    I just hope that poor boy finds something that can make his dad proud of him... or that his dad finally figures out that a possibly short, but *healthy* son is worth celebrating, athlete or not. In my novel, that boy will grow up to be 5'4" and the star of his high school basketball team XD I mean, crazier things have happened!

    1. I almost put that quote in the post! Thanks for your thoughtful comments.