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The Pediatric Forum
June 2007

Only Half the Story—Reply

Arch Pediatr Adolesc Med. 2007;161(6):616. doi:10.1001/archpedi.161.6.616-b

In reply

Carole Marcus suggests that because we did not discuss the patient's breast surgery, our article told only “half the story” and was therefore misleading. We would respectfully disagree. The purpose of reporting this case was to focus attention and debate on the practice of attenuating growth in children with severe developmental disability as a strategy for improving the quality of their lives. There are many aspects of this patient's medical care that do not directly bear on this issue and were not reported. The hysterectomy was included in the discussion only because it was directly related to the complications of estrogen treatment. The medical rationale for hysterectomy is well covered in the article. Breast bud removal was a completely separate request and raised a different set of issues that were unrelated to growth attenuation (as was the incidental appendectomy that was performed).