Table 3 Considerations and findings from a psychosocial viewpoint that plead for and against height enhancing hormone treatment in children with idiopathic short stature.

	Impact of short stature	Risk and protective factors	Hormone treatment
For	Several of the medically referred children have behavioural and social problems as evaluated by parents. Physical appearance will have consequences in terms of how people are judged and treated by others and may affect future prospects of finding a spouse or job.	Increasing height might be a solution to improve adjustment, because several risk factors affecting adjustment cannot or can hardly be manipulated, e.g. being a boy, having low intelligence, having a younger but taller sibling, or being part of a family with a low socioeconomic status.	Parents and children retrospectively perceive the hormone treatment as positive.
Inconclusive	The few studies that have assessed the children's opinion suggest that medically referred children themselves do not perceive psychosocial problems. It is not known whether medically referred children with idiopathic short stature have (according to their parents) psychosocial problems because of their short stature or whether short children with psychosocial problems are medically referred relatively often.	The extent to which adjustment to short stature is affected by common protective factors such as temperament, coping strategies, and support from significant others, is unknown.	Nothing is known about potential determinants of individual differences in psychosocial functioning after hormone treatment. Long term results of hormone treatment are not available yet.
Against	Not all medically referred children with idiopathic short stature have psychosocial problems, and short children who are not medically referred do not seem to have psychosocial problems at all.	The risk and protective factor model of adjustment offers several opportunities for psychological guidance and social interventions aimed at psychosocial stressors, coping strategies, and social support. Changing these factors might improve adjustment by protecting the child against the impact of short stature.	There are few evidence based positive effects of the treatment on psychosocial functioning. A considerable part of the hormone treated individuals remains relatively short, leading to the question of how much height needs to be gained to improve psychosocial functioning.