CHILDREN / Tall tales and short stories: Teenagers can suffer agonies because of their height, says Annabel Ferriman. But attempts at cure can be worse

SARAH HOPE was already 6ft 1in tall by the age of 11. She was a much-loved only child, with parents who never made an issue out of her exceptional height, and her days at primary school were happy ones. 'But as soon as I hit secondary school, my height became a problem,' she says.

'At primary school I had been in friendly competition with a boy who was also tall, to see which of us was going to reach six foot first. It was fun and being tall seemed a positive thing, but the first few years of secondary school were a nightmare. I was teased mercilessly, victimised and bullied. I could not get a school uniform that fitted, so I always looked odd, and people used to steal my books, steal bits of clothing and reduce me to tears.'

Sarah, a personnel manager from Cambridge, is now 38 and 6ft 4in tall. 'I finally came to terms with my height in my late twenties, when I had my first serious boyfriend,' she says. 'I now find it useful in business because it gives me authority.'

Growing up is painful for most people, but growing up the 'wrong' shape or size can make adolescence a misery. Teenagers who are perceived by themselves or others as too tall or too short, too fat or too thin, can suffer teasing, bullying and humiliation from their peers and develop strong feelings of inferiority that follow them into later life.

The effects of teenage obsession with body shape are well attested in the increasing number of girls who develop eating disorders such as anorexia nervosa or bulimia. Around 15 per cent of teenage girls are now underweight, and about one per cent anorexic. Teenage boys, too, worry about obesity, although it is rare in this age group. A recent survey by Jane Thomas of the nutrition and dietetics department at King's College, London, showed that among 12- to 13-year-olds a fifth of boys and two-fifths of girls wanted to lose weight.

To achieve the perfect figure, teenagers themselves can go to extraordinary lengths. To reach the right height, however, requires even more drastic action. In these cases, the parents are frequently more worried than the child, many having suffered teasing themselves when they were young. Where do these people turn for help and what are the options open to them?

'It is relatively easy to treat girls who are going to grow extremely tall,' says Professor Charles Brook, who runs a growth clinic at the Middlesex Hospital, London, treating about 600 new patients a year. 'We know that girls grow only 30cm (1ft) from the onset of puberty, so if you do not want a girl to grow to more than 180cm (6ft), you need to induce puberty early, when she is no more than 150cm (5ft).' Puberty can be brought on artificially early by giving girls small doses of the hormone oestrogen.

Helping children who are going to be exceptionally small is harder, however. Professor Brook's clinic has, in the past, offered human growth hormone injections for children who are constitutionally small, rather than growth- hormone deficient (which leads to other problems such as a failure to reach sexual maturity), but such treatment rarely adds more than an inch to their final height. 'Human growth hormone should be reserved for those who are deficient in it. Otherwise children suffer 10 years of daily injections, costing pounds 7,000 a year, to gain just one inch.'

Professor Brook believes strongly that medical intervention should be used sparingly. 'When children are being given human growth hormone, it is the parents who have to administer the injections. Each time they do so, they are giving the child the message that there is something wrong in being small. We have often had to provide a great deal of psychological support for those who have gone through the treatment.'

The danger of intervening medically is well illustrated by the tragic events now unfolding as a result of patients being given human growth hormone in the 1970s and early 1980s. Twelve people have developed the fatal brain disorder Creutzfeldt-Jakob disease, after being given hormone extracted from the pituitary glands of infected dead bodies. Since the disease has a 15-20 year incubation period, it is not known how many more of the 2,000 children treated will develop it. The hormone was withdrawn in 1985, and since then a synthetic version has been used.

'We as parents do not always make the best decisions for our children,' Professor Brook adds. 'It is often better to help them to come to terms with their height than to try and manipulate it.'

Dr David Weeks, a consultant psychologist at the Royal Edinburgh Hospital, who knows all about the problem of size since he is only 5ft 2in, agrees wholeheartedly. 'Parents should not adopt a vigorously interventionist approach. I know a very tall teenage girl whose father wanted her to have an operation to remove some of the bone from her legs to make her shorter. She said to him: 'Look, I am training to be an engineer and I know that if you break things that support weight they are never as strong afterwards. Thanks, but no thanks.' '

Dr Weeks does not think that the answer lies in medical intervention, but in helping adolescents to came to terms with their perceived 'problem'. 'If human growth hormone had been around when I was 14 or 15, I would have demanded some. I am now glad it was not,' he says. He remembers having a hard time in his teens. 'From 11 to about 16, I had a great sense of inferiority. I thought that if only I would grow, it would be a magic solution to all my problems. It would put everything right. I was very sports orientated. I played American football (I grew up in New York city) with people who weighed two and a half times as much as me, which was a dangerous thing to do.'

Dr Weeks now lectures on 'heightism' and the discrimination that small people often face. 'People tend to think that short men are going to be inappropriately assertive to prove their machismo, but there is no evidence for that at all,' he says.

For many parents, it is extremely painful to watch their children go through these problems. So what should they do? 'It is important that parents do not express their own anxieties,' says Dr John Coleman, director of the Trust for the Study of Adolescence in Brighton. 'Kids have enough anxieties about their bodies without parents adding to them.

'Parents should not be saying: 'Oh dear, you are much smaller than everyone else in the class. Perhaps I should take you to the doctor.' Or: 'Your breasts are not developing. Perhaps you should have hormone injections.' If the parents are very worried they should go and see the doctor, without the child. There is a lot of pressure towards the perfect physique, from the media and so on. Parents should help their children understand that we are all different and that a person's physique is not all there is to someone.'

Adults should also realise that adolescents develop at different rates. 'Puberty does not necessarily start or end at the same time for everyone. For some children, it can start at nine or 10. For others it is delayed until 13 or 14. This does not have any implications for their later development.'

Both Coleman and Weeks believe that the single most important thing that parents can do to help children who are worried about their size and shape is to build up their self confidence. 'Look for the things they are good at. Support what they do. We know that one of the most powerful factors that affects a teenager's self-esteem is his or her parents' interest,' says Dr Coleman.

'All the evidence shows that parents are as important to teenagers as they are to young children, but in a different way. It is often hard for parents during this period, because teenagers are often rejecting towards them, but research shows that teenagers do not want their parents to say: 'OK. Go ahead. You are on your own now.' '

Dr Weeks says: 'It is the parents' responsibility to maximise their children's gifts. They have to balance the perceived deficit that the teenager is focusing on with his or her other gifts, and show them that their shape is only a small part of their overall personality.

'Growing up as an exceptionally small teenager, I was always struck by the cruel tactlessness of adults. Like all teenagers, I wanted to look older, or at least as old as my age. But this common feeling seemed to be beyond their understanding.

' 'How old are you now?' they would inquire. 'Sixteen,' I would say, trying very hard to look taller than my 5ft. 'Goodness, are you? You only look about 12.' 'And how old you now?' I wanted to say. 'Forty-two? Goodness, you look at least 60.' '

'Teenagers in the Family', including booklet and cassette, is available from Trust for the Study of Adolescence, 23 New Road, Brighton, East Sussex BN1 1WZ, price pounds 7.95.

(Photograph omitted)