Should hormone therapy be used to make children with profound impairment smaller? This question—having within it the key elements of a modern tragedy—needs to be handled with supreme care regarding both the predicament it addresses and the treatment it proposes.
Consider the predicament: among the many extraordinary problems confronted by parents of children with profound cognitive and physical disabilities, figuring out how to provide care as the child grows into an adult is among the most difficult to solve and distressing to contemplate. When parents age and face disability themselves, many find increasingly difficult the tasks of bathing, diapering, and transferring their adolescent and adult children, who have grown larger, heavier, and perhaps stronger. Additionally, as the child transitions from the pediatric into the adult system of medical and social services care, parents often have less access to personal care aids or to useful but expensive devices such as mechanical lifts. Having devoted much of their lives to meeting the basic daily needs of their child, many parents find themselves forced to find out-of-home placements for their son or daughter.