When the generalization becomes an expectation, there lives a stereotype.
Men are generally taller than women. There’s the generalization.
Men are tall or at least the real men are supposed to be tall. And there’s your stereotype.
Sam is a little guy. Even for a toddler, he’s small. Sure, he could go through a growth spurt at 14, sprouting gangly limbs and lurching around awkwardly, and end up a 6 foot tall giant. I don’t think it’s likely though. Did you pick up on the fact that I think 6 feet tall is a giant? That just might hint to you at how tall, or to change the perspective – how short, I am. I’m 5’3”. Jack is 5’5”. It seems likely then that our son Sam will follow the family trend.
When Jack was 18 months old he stopped growing for a while. For six months his growth had completely ceased, and then it began again, perhaps more slowly than normal. He was poked and pricked and tested for the next several years while he fell to the bottom of the growth chart. By fifth grade his buddies, the bullies, and the rest of his classmates towered over him by several inches or much more.
From x-rays of his hand and wrist, Jack was diagnosed with constitutional growth delay. It’s a condition whereby one’s physical age is younger than one’s chronological age. What? Yeah, I don’t really grasp a medical understanding of it either. But I do understand that it causes the kid to be behind his peers, growth-wise. Interestingly though, it does not cause any physical health problems; the individual should eventually reach full height and maturity albeit much later than everyone else.
In Jack’s case, six months of no growth was combined with short family genes and a case of ordinary late bloomerism. (The family trait of late bloomerism was evident in his brothers, too, who were also the shortest kids in their grades until their growth spurts naturally kicked in during junior high. However, while there’s no doubt that the brothers were short kids, the gap between Jack and his classmates was greater. As adults his brothers are 5’9” and 5’10”; there are a few tallish genes floating around the family tree. I think shortness reigns though. Jack, at his adult height of 5’5”, is still taller than both of his parents.)
You can imagine that, for many, the years of adolescence is rife with insecurity and general misery as a kid navigates the sometimes hellish social ecosystem that is middle school and high school. (It could be unpleasant for us nerdy types anyway.) In a population that, like most of society, values height, physical strength, and athleticism in males, how much more difficult do you think adolescence might be for a small boy? The problem with constitutional growth delay then isn’t one of poor physical health; it is a social problem. Additionally, constitutional growth delay does not only affect height; puberty is also delayed. It’s hard enough to ask a girl for a date. It must be even harder when you have the body of a younger boy.
Jack’s parents made the decision to start Jack on doses of testosterone by sixth grade. He’s glad they did. It gave his growth a much-needed jumpstart. Specifically, he was able to enter the not-so-magically-wonderful world of puberty. He gained all those delightful additions of hair in funny places and other awkward changes, and his voice transformed into the voice I know and love. He was still short but started making greater progress towards reaching his full mature height.
Fast forward thirty odd years, and here we have our sweet Sam.
Having gained a mere 4 oz since his six month check-up, at Sam’s nine month appointment he weighed 15 lbs and 9 oz. And he grew one inch. Our wonderful pediatrician Dr. Morton noted that although Sam was at the bottom of the growth chart, he looked healthy and happy. And he does; Sam has good muscle tone, healthy color, not scrawny looking at all. He looks like a completely healthy baby, but a bit miniature sized. Dr. Morton at this point is more concerned about Sam not gaining any weight than about his length. He said it was time to work another meal into Sam’s diet. Jack and I followed his advice, and it’s been three meals a day now. Lately Sam has been my little piggy; by which I happily mean that he has had a healthy appetite. At first we were only giving Sam about a ¼ cup of food for a meal, and he seemed satisfied with that (not even finishing that all the time.) But in addition to increasing the frequency of meals we’ve also increased the amount. Sometimes it’s ⅓ cup, ½ cup or even more depending on his appetite and mood. We make our own baby food: a mix of fruits, veggies, yogurt, chicken, and some cheese. I’m no farmer; when I say “make” I mean that I buy fresh organic produce and dairy and cook/mash/puree it. I still breastfeed Sam five or six times a day. Jack gives him an 8oz bottle of formula at bedtime—a remnant from the very early days when we had to supplement my breast milk. Now it gives me a much-needed, much-appreciated break in the evenings!
Tomorrow we go back to the pediatrician to check on Sam’s growth. It’s been six weeks. With all this yummy and nutritious food in his diet, I’m hopeful that we’ll see some significant weight gain. In fact I’d be very surprised if we don’t because, as Jack joyfully pointed out to me last week, Sam’s thighs have put on some extra chubbiness. When he’s being changed, Sam lies on the changing table and points his feet straight up in the air. Now I grab his legs and jiggle his thighs and gleefully sing “Chuuubbyyy thiiiighs!!!” and he laughs and laughs and laughs.
I can see the chubby thighs, but I don’t see any evidence that he’s grown in length at all, but who knows? Chubby thighs certainly indicate a positive weight gain, but there may still be some trials ahead. What would we do if Sam had constitutional growth delay? Would we give him testosterone? Some parents in that situation might even opt for the more extreme growth hormone treatment. Thank God that Jack’s parents didn’t do that. The children who took the newly available growth hormone in the 1970s didn’t fare so well as they got older. I don’t know about growth hormone for Sam. That feels extreme, and definitely doesn’t seem very crunchymunchy to me. Lastly, I get to what I see as the crux of the situation. Sam’s emotional well-being.
How do Jack and I teach Sam that height doesn’t matter nearly as much as society may lead you to think it does? How do we instill confidence in Sam, or help and support him in having confidence in himself? Jack had a friend in high school who was also shorter than most of the guys. Ted, however, was brimming with confidence, and nobody messed with him. What was Ted’s secret? And how do we raise Sam to not feel as though his height is a plague upon him? Jack believes that all children have a moment where they realize that they are different from other children in an undesirable way. For Jack, it was his height. The undesirability of the trait may be all in the child’s own head (for example maybe it’s glasses or red hair that marks them as different) but that doesn’t make the feelings and self-consciousness any less real. If height proved to be an insurmountable obstacle to Sam surviving the teenage and college years happily and perhaps an obstacle to romance as well, but there was some way we could improve the situation, wouldn’t we want to do it? If we decided to use testosterone treatment to advance growth, how would we do that while simultaneously preaching that Sam was perfect and beautiful exactly the way that he was? Perhaps most importantly, how do we raise Sam to be able to love himself and be comfortable in his own skin? And how do we do that in a world that loves tall men, and where short men are often the butt of a joke?