Q & A

Why Follow Dr.Deb

Dr. Deb has dedicated her life as a pediatric endocrinologist, not only to helping the patients she sees in her practice but to changing the way children cope with chronic conditions. They are more than statistics. These children are experiencing the growing up with the added challenges of the emotions that go along with being different. For example, how can children explain their condition to their friends?

Dr. Deb recommends honesty. But this does not mean oversharing. Health information does not necessarily need to be shared If the friend or friends’ family is not supportive. The key is for the child to have easy answers when these questions arise. Dr. Deb writes about the emotional impact of pediatric endocrine conditions in her first book Someday When I am Bigger, in her blog and the books she has under development. Subscribe to her newsletter to stay informed.

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Q & A

Most materials regarding treatable growth issues are directed at healthcare providers and parents. I wanted a book that children can relate to and can identify experiences that they have had.

Children who have experienced being small and have also experienced bullying or issues with respect to self-esteem. Although geared for the 6- to 9-year-old age range, a child’s emotions and feelings are ageless.

The character is a composite of many children I have cared for over the years. It does not relate to one specific patient but the many experiences they have expressed.

Being small isn’t necessarily a disease. Being small for your family when your intended height was taller could represent a problem. While being short may not be a disease, growth is a barometer of health. If a child does not grow correctly there can be an issue.
Worldwide the most common reason people grow poorly is malnutrition. Any major chronic disease can cause poor growth. While rare, abnormalities of the endocrine system can cause growth failure. Some patients are missing growth hormone.
Depending on the reason for poor growth treatments are available. Growth hormone is an FDA approved indication and treatment is available. Clearly, if one is malnourished, appropriate nutrition helps growth. If one has an underactive thyroid, thyroid replacement helps growth. So, the answer depends on the specific situation of each individual child.
With Respect to stat ure, the data claims that children approximately at age 9 notice that they are shorter. I suspect this is very individual and depends on the experience of children and their intellectual understanding of height.
Sometimes the signs are very subtle. Children may refuse to be part of the team they have participated in before. They may show some subtle signs of depression. They may be more introverted and want to do individual activities rather than group activities. They also may have some difficulties at school.
The book identifies the issues and experiences that short children have had. The main character is portrayed in a positive light as he understands that his value is not how tall he is. Identification with such a positive character who is Small can be very helpful. Identifying experiences of bullying may allow children to look at their own experiences and perhaps begin to talk about them.
The book gives a jumping off point for parents to discuss much of these issues with their children. Often children do not talk about what happened in school or what happened during sports. The book allows for the discussion about bullying by using a character in the book. This character has experienced bullying has been unable to ride the rides at an amusement park. On the other hand, this Character also won the science fair. Our character chimes in “not all of my value is measured by height”.
By reading the book with their child, they can bring real life experiences of the child or the family to the forefront. The book helps to identify feelings and perhaps some solutions. It is a jumping off place to bring up issues that are difficult to discuss. It perhaps gives an opportunity for the parent to describe some of their own experiences.
When younger children are taller than older children many issues emerge in a family setting. Other children in the family may feel or worry that growth issues may happen to them as well. Sometimes the child with growth issues is a child that has special needs. Because of the many doctor visits, this child may require more time and attention. There needs to be balance as I recommend in the corresponding parent workbook.
The endocrine system is vast. The pituitary gland is the center of control for the endocrine system and directs six different systems. This is in addition to type one diabetes, obesity, brain tumors. We see children with growth issues, multiple syndromes, early and late puberty, adrenal disease, diabetes insipidus, thyroid disease both over and under active, metabolic issues, chromosomal issues to name a few.
Being different is probably the common thread. However, some diseases are life-threatening and have a different degree of seriousness. The emotional responses are going to depend on the individual resources of the child and their degree of maturity.
Speaking with children is very age dependent. Children do not like to be talked down to. It may be helpful for the young child to begin a conversation with drawing a picture of the family drawing a picture of oneself. Asking about friends and asking directly about what they understand about their health issues. Acting out scenarios and imaginative play may be very helpful here. Often diseases run in families. Sharing with one’s child experiences that adults have faced when they were children can be very enlightening.

Answer .Most materials regarding treatable growth issues are directed at healthcare providers and parents. I wanted a book that children can relate to and can identify experiences that they have had.

The book is intended for children who have experienced being small and have also experienced bullying or issues with respect to self-esteem and their parents. It is probably somewhere in the 6 to 9-year-old age range. While the literature is for a younger child, emotions and feelings are ageless.

The Character is a composite of many children I have cared for over the years. It does not relate to one specific patient. Children have experienced many problems with stature and if expressed some of the experiences that are character encounters.

Being small isn’t necessarily a disease. Being small for your family when your intended height was taller could represent a problem. Some children who have late puberty or are late bloomers tend to be shorter. The difference is they grow at a normal velocity. When children do not change clothing size on a yearly basis or change shoe size This can be an issue. If a child crosses percentiles On the growth chart that the pediatrician monitors this is an issue. Well being short may not be a disease, growth is a barometer of health. If a child does not grow correctly there can be an issue.

Worldwide the most common reason people grow poorly is malnutrition. Following this are thyroid diseases.

Any major chronic disease can cause poor growth. This might include heart disease kidney disease hematologic diseases Gastro intestinal diseases and pulmonary diseases. Genetic syndrome’s are associated with short stature. 

Abnormalities of the endocrine system can cause growth failure. Some patients are missing growth hormone.

Dependent on the reason for poor Growth, treatments are available. If one is growth hormone deficient or has a specific syndrome such as Turner syndrome or Russell silver syndrome or Praderr Willi Syndrome or being born small for gestational age, Growth hormone is an FDA approved indication and treatment is available.Clearly if one is malnourished, appropriate nutrition helps growth. If one has an underactive thyroid, thyroid replacement helps growth. So the answer depends on the specific situation of each individual child.

With Respect to stature, the data claims that children approximately at age 9 noticed that they are shorter. I suspect this is very individual and depends on the experience of children and their intellectual understanding of height.

Sometimes the signs are very subtle. Children may refuse to be part of the team they have participated in before. They may show some subtle symptoms of depression. They may be more introverted and want to do individual activities rather than group activities. They also may have some difficulties at school.

Being smaller raises many issues. We live in a society that believes bigger is better. As a result, there can be self-esteem issues that may manifest as acting out behavior. Some children who are small or bullied can become depressed.

The book identifies the issues and experiences that short children have had.  The main Character is portrayed in a positive light as he understands that his value is not how tall he is. Identification with such a positive character who is Small can be beneficial. Identifying bullying experiences may allow children to look at their own experiences and perhaps begin to talk about them.

The book helps parents discuss many of these issues with their children. Often, children do not talk about what happened in school or during sports. The book allows for the discussion about bullying by using a character in the book. This Character has experienced bullying and has been unable to ride the rides at an amusement park. On the other hand, this Character also won the science fair. Our character chimes in “not all of my value is measured by height”.

By reading the book with their child, they can bring real-life experiences of the child or the family to the forefront. The book helps to identify feelings and perhaps some solutions. It is a jumping-off place to bring up issues that are difficult to discuss. It perhaps allows the parent to describe some of their own experiences.

When younger children are taller than older children, many issues emerge in a family setting. Other children in the family may feel or worry that growth issues may happen to them as well. Sometimes the child with growth issues is a child that has special needs. Because of the many doctor visits, this child may require more time and attention.The other children need to be given appropriate attention and time.

Many parents ask me if their child is going to be extremely short. Others are worried about early or late puberty. Many are concerned about chronic disease side effects of medication and the mini-tests and x-rays required to make a correct diagnosis and allow for ongoing monitoring.

The endocrine system is vast. The pituitary gland is the center of control for the endocrine system and directs six different systems. This is in addition to type one diabetes, obesity, brain tumors. We see children with growth issues, multiple syndromes,Early and late puberty, adrenal disease, diabetes insipidus, thyroid disease both over and under active, metabolic issues, chromosomal issues to name a few.

Being different is probably the common thread. However, some diseases are life-threatening and have a different degree of seriousness. Pubertal issues often affect self-esteem in a major way because a child with early puberty who is ten may have the appearance of a 13 or 14-year-old as well as some of the interests of a 13 or 14-year-old. Children with late puberty are often ostracized and do not fit with their peers. Emotional issues are unique to all children. Obesity which is in epidemic proportions, has been called one of the last acceptable prejudices in the world. The public thinks they can say anything about an overweight person. The emotional responses will depend on the child’s individual resources and their degree of maturity.

Speaking with children is very age-dependent. Children do not like to be talked down to. It may be helpful for the young child to begin a conversation by drawing a picture. Then, parents can ask directly about what they understand about their health issues. Acting out scenarios and imaginative play may be very helpful here.

Often diseases run in families. So, sharing with one’s child experiences that you have faced when their age can be very reassuring.

Honesty usually works the best. If the disease is very common like diabetes for example, there may be many preconceived notion’s that may or may not be correct. Health information does not necessarily need to be shared If the friend or friend’s family is not supportive. Sometimes just knowing and seeing the results of growing faster are sufficient for friends of patients.