eMedicine Specialties > Pediatrics: Developmental and Behavioral > Medical Topics

Child Abuse & Neglect, Psychosocial Dwarfism: Follow-up

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

Updated: Mar 11, 2010

Follow-up

Further Inpatient Care

  • The primary purpose of inpatient evaluation of children with psychosocial short stature (PSS) is providing an emergently needed safe environment.
  • A controlled observation period sometimes is necessary to make the diagnosis. This also allows the consultants to take a detailed history of the child and the environment.
  • A pediatric endocrinologist may perform testing requiring close observation and frequent blood work.
  • Initial outpatient evaluation can be performed only if the child already has been removed from the previous environment.

Further Outpatient Care

  • Routine medical care
  • Continuation of hormonal therapy, if needed
  • Close monitoring of growth velocity and weight
  • Mental health treatment, including family therapy if the family remains intact and the child is returned
  • Treatment for any comorbid diagnoses

Inpatient & Outpatient Medications

  • Provide medication as recommended by endocrinology and mental health consultants.

Transfer

  • Hospitalization at a specialized pediatric care facility is desirable. If inpatient treatment is not possible, consultation with pediatric experts at such a facility is warranted at the earliest possible time.

Deterrence/Prevention

  • Prevention of this severe form of child abuse and neglect is possible by early identification of family risk factors for abuse and neglect, identification of FTT or growth failure, and maintenance of a high index of suspicion for child neglect when evaluating pediatric growth failure.

Prognosis

  • Catch-up growth
    • Prognosis for catch-up growth in children with PSS depends on the age of the child, early recognition of the condition, and removal from the unsafe environment.
    • Endocrine abnormalities, sleep aberrations and abnormal EEG patterns, pain agnosia, and behaviors all rapidly improve when the child is removed from the adverse environment.
    • Catch-up growth can be demonstrated on growth curves when the diagnosis is made before adolescence.
    • Limited longitudinal studies are available to state whether children will reach their genetic height potential.
  • Intelligence
    • Prognosis for intelligence in persons with type II PSS is guarded given that the child has come from an abusive or emotionally deprived environment.
    • When placed in an intellectually stimulating environment in early childhood, the child's ability to function at normal range may be maintained.
  • Emotional and psychological stability
    • Prognosis for emotional and psychological stability as adults is poor.
    • Prognosis particularly is guarded for children diagnosed late in childhood.
    • These children may become adults whose emotional and psychiatric health impedes their ability to appropriately parent.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Diagnosis of psychosocial short stature (PSS) in children is usually made after the child abuse and/or neglect already has been confirmed. However, the initial presentation may be growth failure, and, subsequently, child abuse and/or neglect is confirmed.
  • Reporting child abuse is mandated in all US states.
  • A thorough differential in any case of child abuse is essential; however, diagnosis of PSS is made on the basis of the environmental history in the child with growth failure.

Special Concerns

  • Child abuse or neglect is a very emotional and difficult diagnosis.
  • The primary concern always must be the safety of the child.
  • A multidisciplinary team approach affords the best outcome for the child and provides support for the medical and child welfare staff involved.
 


More on Child Abuse & Neglect, Psychosocial Dwarfism

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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

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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
Disclosure: Nothing to disclose.

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 and Behavioral Sciences, Department of Psychiatry, Division Chair, 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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