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Psychosocial Short Stature Follow-up

  • Author: Andrew P Sirotnak, MD; Chief Editor: Caroly Pataki, MD  more...
 
Updated: Feb 17, 2015
 

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
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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.
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Inpatient & Outpatient Medications

Provide medication as recommended by endocrinology and mental health consultants.

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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.

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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.

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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.

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Patient Education

Patient education may vary depending on the developmental level or learning disability of the child when diagnosed.

For patient education resources, see the Growth Hormone Deficiency Center, as well as Growth Failure in Children, Growth Hormone Deficiency, and Growth Hormone Deficiency FAQs.

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Contributor Information and Disclosures
Author

Andrew P Sirotnak, MD Professor and Vice Chair of Faculty Affairs, Department of Pediatrics, University of Colorado School of Medicine; Department Head, Child Abuse and Neglect, Director, Child Protection Team, The Children's Hospital

Andrew P Sirotnak, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chief Editor

Caroly Pataki, MD Health Sciences Clinical Professor of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, David Geffen 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, Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Additional Contributors

Chet Johnson, MD Professor of Pediatrics, Associate Director and Developmental-Behavioral Pediatrician, KU Center for Child Health and Development, Shiefelbusch Institute for Life Span Studies; Assistant Dean, Faculty Affairs and Development, University of Kansas School of Medicine

Chet Johnson, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

References
  1. 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].

  2. 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].

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

  4. 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].

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  7. 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].

  8. Sandberg DE, Colsman M. Assessment of Psychosocial aspects of short stature. Growth, Genetics and Hormones. June 2005. 21(2):[Full Text].

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

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

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

  16. 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.

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

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Growth curves of 5 children with psychosocial short stature are depicted. In each instance, the increase in the slope of the curve occurred simultaneously with removal from the adverse home environment. The asterisk (*) notes the time of this removal.
 
 
 
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