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Child Abuse & Neglect: Psychosocial Dwarfism: Differential Diagnoses & Workup

Author: Andrew P Sirotnak, MD, Department Head, Child Abuse and Neglect, Director, Kempe Child Protection Team
Contributor Information and Disclosures

Updated: Mar 19, 2008

Differential Diagnoses

Child Abuse & Neglect: Failure to Thrive
Eating Disorder: Rumination
Growth Failure
Growth Hormone Deficiency
Skeletal Dysplasia

Other Problems to Be Considered

Undiagnosed chronic illness
Undiagnosed congenital abnormality
Primary GH deficiency
Idiopathic GH deficiency
Primary psychiatric diagnosis
Other organic causes of FTT

Workup

Laboratory Studies

  • Order baseline screening for FTT to exclude common organic causes of growth failure. In psychosocial short stature (PSS), results of these tests are within the reference ranges. Baseline screening for FTT includes the following:
    • CBC count
    • Urinalysis
    • Renal function screens (BUN, creatinine)
    • Stool for ova and parasites
    • Stool fat analysis
    • Sweat test (if cystic fibrosis is suspected)
  • A pediatric endocrinologist should evaluate the endocrine dysfunction observed in these patients. A heterogeneous pattern of abnormalities is observed in persons with type II PSS.
  • Fasting GH levels are less than the reference range in individuals with type II PSS, and fasting GH levels are within the reference range in persons with type I PSS and type III PSS. Arginine stimulation testing often fails to release GH in individuals with type II PSS. Administration of GH to patients with type II PSS produces minimal or no growth response and induces only a minimal rise in Sm-C or insulinlike growth factor-1 (IGF-1).
  • Sm-C and IGF-1 levels have been demonstrated to be low in the limited number of children with type II PSS who have been tested. These levels have been shown to normalize when the child is removed from the adverse environment. Sm-C and IGF-1 levels are within the reference range in persons with type III PSS.
  • Corticotrophin (ACTH) secretion measured by metyrapone testing can be abnormally low in persons with type II PSS. ACTH secretion eventually normalizes when the child is in a nurturing environment.
  • Thyroid function determined by iodine uptake can be outside of the reference range. Peripheral thyroxine (T4) levels are usually within the reference range in individuals with all types of PSS.

Imaging Studies

  • No routine radiology studies are needed. If review of history or physical examination is suggestive of skeletal trauma, appropriate radiographs should be obtained.7 If the mental status examination is markedly abnormal, obtain imaging studies of the brain exclude brain tumor, the most common solid tumor of childhood.
  • Severe abdominal distention or signs of bowel obstruction may prompt evaluation with abdominal plain film radiography or upper gastrointestinal (UGI) series. Bezoars from food gorging and nonspecific alterations of bowel motility have been reported.
  • Temporary widening of the cranial sutures has been reported and may be related to the rapid increase in brain growth during catch-up growth in height and weight.
  • Temporary growth arrest lines can be observed in metaphyses of the long bones.

Other Tests

  • EEG abnormalities have been reported in the early phase of type II PSS in hospitalized children with the condition.
  • Decreased slow-wave sleep (stages III and IV) has been demonstrated; however, this reverses to normal when the child is removed from the adverse environment.

Procedures

  • No routine procedures are necessary for diagnostic evaluation.

More on Child Abuse & Neglect: Psychosocial Dwarfism

Overview: Child Abuse & Neglect: Psychosocial Dwarfism
Differential Diagnoses & Workup: Child Abuse & Neglect: Psychosocial Dwarfism
Treatment & Medication: Child Abuse & Neglect: Psychosocial Dwarfism
Follow-up: Child Abuse & Neglect: Psychosocial Dwarfism
Multimedia: Child Abuse & Neglect: Psychosocial Dwarfism
References
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References

  1. Money J. The syndrome of abuse dwarfism (psychosocial dwarfism or reversible hyposomatotropism). Am J Dis Child. May 1977;131(5):508-13. [Medline].

  2. Tarren-Sweeney M. Patterns of aberrant eating among pre-adolescent children in foster care. J Abnorm Child Psychol. Oct 2006;34(5):623-34. [Medline].

  3. Duche DJ. [Consequences of family violence on children's health]. Bull Acad Natl Med. 2002;186(6):963-9; discussion 969-70. [Medline].

  4. Albanese A, Hamill G, Jones J, et al. Reversibility of physiological growth hormone secretion in children with psychosocial dwarfism. Clin Endocrinol (Oxf). May 1994;40(5):687-92. [Medline].

  5. Stanhope R, Wilks Z, Hamill G. Failure to grow: lack of food or lack of love?. Prof Care Mother Child. Nov-Dec 1994;4(8):234-7. [Medline].

  6. Sandberg DE, Colsman M. Assessment of Psychosocial aspects of short stature. Growth, Genetics and Hormones [serial online]. June 2005;21(2):Accessed October 10, 2007. Available at http://www.gghjournal.com/volume21/2/featureArticle.cfm.

  7. Gloebl HJ, Capitanio MA, Kirkpatrick JA. Radiographic findings in children with psychosocial dwarfism. Pediatr Radiol. Feb 13 1976;4(2):83-6. [Medline].

  8. Blizzard RM, Bulatovic A. Syndromes of psychosocial short stature. In: Pediatric Endocrinology. 1996:83-93.

  9. Fazil Q. Dwarfism: Medical and psychosocial aspects of profound short stature. Psychiatr Bulliten [serial online]. 2006;30:Accessed October 10, 2007. Available at http://pb.rcpsych.org/cgi/content/long/30/11/439.

  10. Green WH, Campbell M, David R. Psychosocial dwarfism: a critical review of the evidence. J Am Acad Child Psychiatry. Jan 1984;23(1):39-48. [Medline].

  11. Inokuchi M, Hasegawa T. [Deprivation dwarfism]. Nippon Rinsho. May 28 2006;Suppl 1:102-4. [Medline].

  12. Lifshitz F, Tarim O, Smith MM. Nutritional growth retardation. In: Pediatric Endocrinology. 3rd ed. 1996:103-20.

  13. Northam EA. Neuropsychological and psychosocial correlates of endocrine and metabolic disorders--areview. J Pediatr Endocrinol Metab. Jan 2004;17(1):5-15. [Medline].

  14. Patton RG, Gardner LI. Short stature associated with maternal deprivation syndrome: disordered family environment as cause of so-called idiopathic hypopituitarism. In: Endocrine and Genetic Diseases of Childhood and Adolescence. 2nd ed. 1975:77-87.

  15. Swanson H. Index of suspicion. Case 3. Diagnosis: failure to thrive due to psychosocial dwarfism. Pediatr Rev. Jan 1994;15(1):39, 41. [Medline].

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Further Reading

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Keywords

psychosocial dwarfism, child abuse, child neglect, psychosocial short stature, PSS, abuse dwarfism, emotional deprivation dwarfism, reversible hyposomatotropism with dwarfism, functional hypopituitarism, psychosocial growth failure, garbage can syndrome, delayed puberty, depression, failure to thrive, abuse and neglect, polyphagia, polydipsia, insomnia, speech retardation, cognitive retardation, psychomotor retardation, depression, anxiety, personality disorders, substance abuse, steatorrhea, hepatomegaly

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Contributor Information and Disclosures

Author

Andrew P Sirotnak, MD, Department Head, Child Abuse and Neglect, Director, Kempe Child Protection Team
Andrew P Sirotnak, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Medical Editor

Chet Johnson, MD, Medical Director, Child Development Unit, Department of Pediatrics, Professor, University of Kansas Medical Center
Chet Johnson, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine.com, Inc
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

CME Editor

Carrie Sylvester, MD, MPH, Director of Education in Child and Adolescent Psychiatry, Professor, Departments of Psychiatry and Pediatrics, Northwestern University Medical School
Carrie Sylvester, MD, MPH is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, American Academy of Pediatrics, American Medical Women's Association, American Psychiatric Association, and American Society for Adolescent Psychiatry
Disclosure: Nothing to disclose.

Chief Editor

Caroly Pataki, MD, Professor of Clinical Psychiatry, Department of Psychiatry and Biobehavioral Sciences, Division Chair of Child and Adolescent Psychiatry, Director of Training, Child and Adolescent Psychiatry Residency Program, University of Southern California Keck School of Medicine
Caroly Pataki, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, New York Academy of Sciences, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
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