‘She’s living in the forest?! And those small things are looking her after? Those unpleasant and unusually small, strange things. They should be banished from the kingdom! Unpleasant… small… strange… things…’ Her words continued to haunt me. The Queen was evil and narrow-minded. I may be small and dopey, but I definitely wasn’t strange.
Snow White, on the other hand, was caring and kind-hearted. She understood why we were small and didn’t treat us any different. She came across our tiny cottage when the huntsman told her to leave the Queen’s palace. Since then, she has looked after us like her family, always cooked for us, made our beds and kept our cottage clean and orderly whilst we were at work.
After hearing the Queen’s nasty words, Bashful became very upset and didn’t understand why he was so different to everyone else. ‘Why are we so short? Why do we always get bullied? This isn’t fair!! Why are we like this?’ cried Bashful. I felt helpless. I myself didn’t have an answer. Maybe this is why they call me Dopey…
Snow White then gathered us all around the fireplace and made us all hot chocolate; mine with extra marshmallows!! J In her soothing voice, she began to explain more about why we were are a little bit shorter than the people of the Kingdom…
‘You are no different from everyone else. What you all have is called ‘short stature’. This means that you have a height that is two standard deviations below the mean height for someone of your age and gender. Another definition involves your parents; here, short stature is where you are more than two standard deviations below your mid-parental height.’
‘But why does this matter?!’ groaned Grumpy.
‘Sometimes Grumpy, it is important to monitor a growth rate, especially in young children, to see if there is anything abnormal with the way their body works. Often, no cause is found. But sometimes, causes are found.’
‘What sort of causes?’ asked Sneezy. ‘Aaa-choo!’
‘Bless you! There are three main reasons; the condition may be due to a problem with the growth plate of the bones, or the growth plate of the bones may be affected by another condition or sometimes no cause is found. It may also run in the family. Certain genetic conditions such as Down’s Syndrome and congenital bone disorders such as osteogenesis imperfecta can cause primary growth problems. Babies may also suffer growth restrictions whilst being in their mother’s stomach, also causing short stature.’
‘Oh, I see’ yawned Sleepy, ‘ and what are the other conditions that may have an affect on a person’s growth?’
‘There are many reasons, Sleepy’, continued Snow White. ‘Some hormone conditions such as hypothyroidism, growth hormone deficiency and Cushing’s syndrome can also affect the growth plate. Poor control of type I Diabetes Mellitus can also be a contributing factor. Some metabolic conditions such as glycogen storage disease may also impact your growth. The list is endless. Chronic conditions such as heart, lung, kidney or blood disorders, juvenile arthritis, malnutrition, bowel obstruction, enzyme deficiencies, inflammatory bowel disease, anorexia nervosa, rickets, certain medications like steroids, the list goes on!’
‘We’re not alone! We’re not alone!’ exclaimed Happy.
‘No Happy, you’re not alone! There are lots of people in the Kingdom that may have short stature for one reason or the other. It can be easily clinically diagnosed by taking a simple history and exploring whether it runs in your family by asking about your mother and father’s height, any nutritional or diet problems, asking certain questions about your birth…’
‘We’re not alone!!’ Happy continued to shout.
Snow White smiled. ‘A simple physical examination measuring your height using a calibrated stadiometer is carried out. Doctor’s may also look for any obvious signs of growth hormone deficiency or features of any other associated conditions that may affect growth. They carry out a full examination, using an equation to calculate your final height. This takes into account your mother and father’s height too, and is different if you are a boy or a girl. Sometimes, if they already have an idea of what the cause may be, they may carry out some blood tests, ask for a urine sample, karyotype your cells…’
‘What does karyotype mean?’ I asked.
‘This is a procedure where they look at the chromosomes in your cells to see if you have any genetic conditions. There are also specific tests for certain diseases. Occasionally, they may even check your bone and dental age, as this gives a good guidance as to whether you have short stature or not. According to your results, you may be referred for further support and management if necessary. In certain situations, they may even give you growth hormone treatment but this depends on the cause of your short stature. You are all beautiful and amazing people. Remember, good things come in small packages! Do not listen to that evil Queen – she is horrible! Don’t let her affect you!’ said Snow White.
Bashful smiled and gave Snow White a big hug. ‘Thank you!’ he said. We all then cheered in happiness and vowed to never let the evil Queen’s words affect us again. We all lived happily ever after. ‘Hi Ho, Hi Ho, it’s off to work we go…’