Table 3.

Seven categories of 22 distinct concerns raised by parents regarding a short child (illustrative comments from parent explanatory groups provide further insight into the specific concerns)

Category	Distinct concern (specific survey item)	Illustrative comments from explanatory groups
Treatment characteristics	Whether the available treatment has been researched and what were the results. Concerns about side effects or fear of possible outcomes from available treatment.	-‘Our pediatrician suggested that there was some options for our daughter, but we thought about the side effects. And I didn’t think that her health was worth the risk of height, of her getting taller, height.’ -‘…it always goes back to if they’ve shown me that these medications are a certain percentage effective. We’re not in the trial phase of the medicine sort of thing.’
Health	Health issues are causing the child’s short height. The child’s short height is causing health issues. The child is experiencing physical pain or discomfort as a result of their short height. The child’s doctor or nurse believes the child’s height may be a problem.	-‘…I feel like every parent should want their child to be healthy. If it’s a health issue, then I’m going to do whatever I need to do…’ -‘…you want your child healthy before you worry about how tall they are…’
Psychosocial functioning	The child’s behavior has changed (feeling depressed, acting out). The child is bothered or concerned about their own height. The child is experiencing bullying or teasing. The child is treated differently than their peers because of their height. The child feels isolated or withdrawn from their peers as a result of their height. The child is not able to participate in activities with peers (such as playing sports, going on amusement park rides). The parent wants the child to be well adjusted and have a positive body image.	-‘I will not seek medical treatment because my child is having social issues. I will teach coping skills. I will work on increasing self-esteem. Building resiliency, which is important, I think, for all kids in today’s world. If need be, I will seek a mental health professional to help support that. Because the reality of it is if it’s not your height, it’s going be something else. You have to learn how to navigate socially in society…’ -‘…I feel that parent could do that because they might be concerned about the child’s feeling when blending in with their peers. …If the child is highly impacted by their height, I think that could lead a parent to - because I would have maybe done so if it were bothering my kid, my child.’
Physical appearance	The child is a ‘midget’ or a ‘dwarf’. The child’s growth is disproportionate (different body parts are growing at different rates).	-‘[Dwarfism] means not only a short person, but also a physically disproportioned.’ -‘To me, those are more, probably not appropriate terms anymore, medical terms for medical issue… Is it a clearly different looking person than a regular kid who was just shorter than the other kids… there are other medical issues that come along with having that… that is a whole other thing than just being a short kid.’
Adult success	The child’s height would change the child’s behavior, happiness or fulfillment during adulthood. The child’s short height would limit the child’s career choice as an adult.	-‘People take taller people a little more serious than they will a shorter stature person, so I think it would impact their overall earning performance over their lifetime.’ -‘.…I know some many successful people who are short, I mean, I work with people who are like brilliant and smart and successful and 5 ft. tall.’
Comparison	The child’s growth chart percentile or their pattern on the growth chart may be worrisome. The child’s height is short compared to their peers.	-‘…when I lived in, in a certain areas, and I lived in South Philly… everybody was my size… and if you were a little bit bigger, you were a little bit bigger. But it was no big deal… and I moved out to the suburbs, that was when I started working out here and everybody was, oh, my God, you’re so short.’ -‘If something looked unusual, especially compared to the rest of the family, I’d probably research that personally… and then talk to the doctor about it.’
Cultural/demographic features	The family’s religious beliefs. Whether the child is a boy or a girl. The child’s race or ethnicity.	-‘I felt like everything was in God’s hands, then I probably wouldn’t - I’d be like look… God made you like this. You 5 ft., you 16. You may get taller. You may not. Deal with it. That’s the hand that God dealt you… from a religious perspective, maybe that’s something a religious person would think.’ -‘I think culturally, if we tell the truth, it’s okay for girls to be small… but it’s not as okay for boys …I think that’s an American thing.’ -‘Like they’re supposed to be manly, you know what I mean. They’re supposed to be manly, there’s that stigma from society, you’re supposed to be a man, you’re supposed to be bigger than the girls, you’re supposed to be, strong and everything else.’ -‘There’s so many other issues to be concerned about in the African-American community that I don’t think that… height and trying to address that through medicine would come at the top of the tier here… on the other side, a family that may be more affluent, uh, particular a Caucasian family, maybe that would be something that they would consider.’