Status battle for tall children hits new heights, and a few lows

Chinese parents have always been anxious about their children's academic performances and excellence in extracurricular activities, but now that competitiveness has been extended to include height.

"Height is increasingly seen as a marker of socioeconomic success and personal potential. Parents' investments in their children's growth reflect deeper ambitions for social mobility and enhanced opportunities," said Yu Hai, a sociology professor at Fudan University.

More and more parents are turning to medical interventions from an early age, hoping to help their children grow taller through puberty suppression treatments and growth hormones.

Lin Yiran, a 40-year-old mother from Hangzhou, Zhejiang province, has found herself at the center of a heated public discussion after it was revealed that her 15-year-old son, Xiao Rui, underwent five years of growth hormone therapy to boost his height.

The treatment began five years ago when Xiao Rui measured less than 130 centimeters — far below the median height of 140 cm for boys his age.

Concerned about his growth, Lin took him to the hospital for a thorough assessment. "When I saw him standing next to his classmates, it broke my heart. He looked so small, and I worried about how this might affect his confidence and opportunities," said Lin.

Doctors confirmed that Xiao Rui's bone age was normal for his chronological age, but cautioned his genetic potential for a good height was limited by his parents' stature. Lin, at 156 cm, and her husband, at 170 cm, were unlikely to pass on genes for a height exceeding 165 cm.

"The doctor told us bluntly that if we did nothing, he might never hit 165 cm. But with growth hormone therapy, he might have a chance of reaching 170 cm," said Lin.

More than 80 percent of parents hope their son's height will be between 175 and 185 cm, according to the Analysis of Parents' Awareness and Needs Regarding the Height of Preschool Children published by the China National Centre for Women and Children's Health in 2015.

The survey of over 10,000 cases, also found more than 85 percent of parents wanted their daughter's height to be between 160 and 170 cm.

Lin said she decided to proceed with the treatment, despite concerns about the cost and potential side effects.

"It wasn't an easy decision. As parents, we're always weighing risks and benefits, but we wanted to give him every chance," said Lin.

Xiao Rui had to inject human growth hormones every day. The treatment cost approximately 6,500 yuan a month, and Lin spent nearly 80,000 yuan in the first year. Despite the financial strain, the results initially seemed promising, and Xiao Rui grew 12 cm in the first year.

However, in the third year Xiao Rui's annual growth slowed to 7 to 8 cm. Over the past two years, his growth has further slowed to around 5 cm a year.

"Watching the pace slow down was tough. Every injection, and every clinic visit, felt heavier when the results weren't as dramatic as before. Some days, I wondered if it was all worth it," said Lin.

Xiao Rui's height, however, has exceeded expectations. At 15, he stands 171 cm tall — far beyond his predicted height of 165 cm and slightly taller than the median height for boys his age.

"Looking back, it was a long and challenging road, but seeing him confident and standing tall among his peers makes it all worthwhile," said Lin.

While some friends supported her decision, others questioned the need for such measures, and criticized the growing reliance on medical interventions for natural traits like height.

In 2019, the average annual cost of individual growth hormone treatment was 42,700 yuan, according to the 2021 China Growth Hormone Market Research Report.

The effectiveness of growth hormone injections varies from individual to individual, and generally requires 2 to 5 years of injections.

Mom's twin approach

For Xia Ou, a 40-year-old mother of 13-year-old twin girls from Wenzhou, Zhejiang province, it was a complicated decision, but she ultimately discontinued medical intervention for her younger daughter, whose growth lagged behind her sibling.

In late 2020, Xia noticed that her daughters, then aged 9, were shorter than their peers. The older sister measured 132.5 cm and the younger twin was just over 130 cm. Both were below the median height of 134.1 cm for their age.

The younger daughter's case was particularly concerning, and doctors said she was simply of short stature.

Given Xia's and her husband's relatively average heights of 160 cm and 172 cm, she had hoped her daughters could at least reach 160 cm. However, based on their bone age and growth trajectory, doctors predicted that hitting this goal would require a miracle.

"When the doctor said it was unlikely for them to exceed 160 cm without intervention, I couldn't accept it. Height matters so much in society — it's not just about looks, but confidence, opportunities, and how people perceive you," said Xia.

With the younger twin showing early signs of puberty, doctors recommended an aggressive intervention of monthly puberty suppression injections and daily growth hormone treatments. For the older sister, they advised close monitoring and increased physical activity.

Xia decided to begin treatment for her younger daughter in early 2021, while opting for a conservative approach for the older daughter.

"It was the hardest decision I've ever had to make. You want the best for your children, but the idea of giving her injections every day felt like I was putting her through unnecessary pain. Yet, I couldn't let go of the hope that it might help her grow taller," said Xia.

The year-long treatment took its toll. Watching her younger daughter endure daily injections filled Xia with guilt.

"Her abdomen was covered in tiny needle marks. She never complained, but I could see the discomfort in her eyes. Sometimes she'd ask me, 'Mama, is this really worth it?' And I'd tell her, 'Yes, this will help you grow taller.' But I wasn't always sure I believed it myself," said Xia.

The results were disappointing. While the younger daughter gained just 3 cm and narrowly surpassed her sister in height, the family had spent over 100,000 yuan on the procedures.

"We sacrificed so much for those 3 cm — it was heartbreaking," said Xia.

In early 2022, she decided to stop the injections and turned to traditional Chinese medicine (TCM) for a holistic approach that is easier on the body.

The alternative was less invasive, but equally challenging. Every month, Xia traveled between Wenzhou and Hangzhou to consult a specialist in pediatric endocrinology. The TCM treatment aimed to delay puberty and promote growth.

However, the process demanded strict routines that Xia struggled to maintain.

"The doctor kept reminding me to ensure they slept nine hours a night and exercised for an hour daily. But honestly, I couldn't keep it up. I'm not someone who's good at sticking to rigid schedules," said Xia.

By early 2023, when her daughters reached the typical age for puberty, doctors advised ending all interventions to allow for natural development. Within a month of stopping the TCM treatments both girls entered puberty.

Today, the older sister stands 154 cm, while the younger twin is 155 cm — both are still below the median height of 156.3 cm for their age. Despite the emotional and financial costs, Xia has made peace with her decision to stop the treatments.

"I can only console myself with the thought that height isn't everything — it's who they are inside that matters most," she said.