Parental Concerns about Growth in Children and Their Impact on Seeking Medical Evaluation and Treatment

Presentation Number: MON-0136
Date of Presentation: June 23rd, 2014

Pamela A. Cousounis*1, Kenneth R. Ginsburg1, Terri H. Lipman2, Andrew J. Cucchiara3 and Adda Grimberg4
1Children's Hospital of Philadelphia, Philadelphia, PA, 2Univ of Pennsylvania, Philadelphia, PA, 3Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 4Children's Hosp Philadelphia, Philadelphia, PA


Background:Parental concerns play an integral role in deciding who receives growth evaluation and treatment. 

Objective:To examine parental concerns about growth in children and their impact on medical decision-making related to height using a four phase mixed qualitative-quantitative approach.

Methods:Parents of randomly selected children of any height, age 9-14 years, from nine primary care pediatric offices were recruited. In Phases 1 and 2, thirteen open focus groups with 71 parents (40 black, 31 white) and ten nominal group technique sessions with 63 parents (24 black, 39 white) were held to gather information about parental beliefs and attitudes regarding short stature and its medical treatment. Growth concerns expressed by the parent groups were incorporated into a quantitative survey. In Phase 3, a survey, available in English or Spanish, was completed anonymously during the summer of 2012 by parents of other children evaluated at four primary care pediatric offices (2 urban and 2 non-urban) affiliated with a tertiary care pediatric hospital. Recruitment was conducted without regard to height and age of the children.  In Phase 4, parents recruited from the same population used for the first two phases participated in twelve explanatory focus groups (39 black, 38 white parents) to explore the meanings and ramifications of the survey results.  

Results:  Parent groups expressed 22 distinct concerns that could influence a parent’s decision to seek medical care for a short child. 1820 surveys were completed (83% response rate; 1587 female, 231 male). Using a 5-point Likert scale, parents scored degree of impact that each concern would have on their decision to pursue evaluation or treatment if their child was short.   Research team consensus and factor analysis of parent responses led to organization of the 22 concerns into seven categories.  The mean Likert score of the individual concerns for each category was calculated as the summary score for that category.  The category rated as having the greatest effect on parental decision-making was treatment characteristics (including questions about prior research and results, and possible side effects), followed by, in descending order, categories of: health (physical pain or discomfort, clinician concern, and health issues are causing/caused by child’s short height), psychosocial functioning, physical appearance and adult success.  Comparison (child’s height relative to the growth chart or to their peers) and cultural/demographic features (family’s religious beliefs, child’s gender and race/ethnicity) had the least influence.

Conclusions: While psychosocial issues can influence decisions about short stature evaluation and treatment, parental concerns about medical treatment and the physical health of their children have the greatest impact on their decision-making.


Nothing to Disclose: PAC, KRG, THL, AJC, AG