Psychosocial Short Stature Follow-up
- Author: Andrew P Sirotnak, MD; Chief Editor: Caroly Pataki, MD more...
Further Outpatient Care
See the list below:
- 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
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.
Inpatient & Outpatient Medications
Provide medication as recommended by endocrinology and mental health consultants.
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.
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 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.
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 may vary depending on the developmental level or learning disability of the child when diagnosed.
Deltondo J, Por I, Hu W, et al. Associations between the human growth hormone-releasing hormone- and neuropeptide-Y-immunoreactive systems in the human diencephalon: a possible morphological substrate of the impact of stress on growth. Neuroscience. 2008 Jun 2. 153(4):1146-52. [Medline].
Rotoli G, Grignol G, Hu W, Merchenthaler I, Dudas B. Catecholaminergic axonal varicosities appear to innervate growth hormone-releasing hormone-immunoreactive neurons in the human hypothalamus: the possible morphological substrate of the stress-suppressed growth. J Clin Endocrinol Metab. 2011 Oct. 96(10):E1606-11. [Medline].
Money J. The syndrome of abuse dwarfism (psychosocial dwarfism or reversible hyposomatotropism). Am J Dis Child. 1977 May. 131(5):508-13. [Medline].
Tarren-Sweeney M. Patterns of aberrant eating among pre-adolescent children in foster care. J Abnorm Child Psychol. 2006 Oct. 34(5):623-34. [Medline].
Duche DJ. [Consequences of family violence on children's health]. Bull Acad Natl Med. 2002. 186(6):963-9; discussion 969-70. [Medline].
Albanese A, Hamill G, Jones J, et al. Reversibility of physiological growth hormone secretion in children with psychosocial dwarfism. Clin Endocrinol (Oxf). 1994 May. 40(5):687-92. [Medline].
Stanhope R, Wilks Z, Hamill G. Failure to grow: lack of food or lack of love?. Prof Care Mother Child. 1994 Nov-Dec. 4(8):234-7. [Medline].
Sandberg DE, Colsman M. Assessment of Psychosocial aspects of short stature. Growth, Genetics and Hormones. June 2005. 21(2):[Full Text].
Gloebl HJ, Capitanio MA, Kirkpatrick JA. Radiographic findings in children with psychosocial dwarfism. Pediatr Radiol. 1976 Feb 13. 4(2):83-6. [Medline].
Blizzard RM, Bulatovic A. Syndromes of psychosocial short stature. Pediatric Endocrinology. 1996. 83-93.
Fazil Q. Dwarfism: Medical and psychosocial aspects of profound short stature. Psychiatr Bulletin. 2006. 30:[Full Text].
Green WH, Campbell M, David R. Psychosocial dwarfism: a critical review of the evidence. J Am Acad Child Psychiatry. 1984 Jan. 23(1):39-48. [Medline].
Inokuchi M, Hasegawa T. [Deprivation dwarfism]. Nippon Rinsho. 2006 May 28. Suppl 1:102-4. [Medline].
Lifshitz F, Tarim O, Smith MM. Nutritional growth retardation. Pediatric Endocrinology. 3rd ed. 1996. 103-20.
Northam EA. Neuropsychological and psychosocial correlates of endocrine and metabolic disorders--areview. J Pediatr Endocrinol Metab. 2004 Jan. 17(1):5-15. [Medline].
Patton RG, Gardner LI. Short stature associated with maternal deprivation syndrome: disordered family environment as cause of so-called idiopathic hypopituitarism. Endocrine and Genetic Diseases of Childhood and Adolescence. 2nd ed. 1975. 77-87.
Swanson H. Index of suspicion. Case 3. Diagnosis: failure to thrive due to psychosocial dwarfism. Pediatr Rev. 1994 Jan. 15(1):39, 41. [Medline].