Child Abuse and Neglect, Psychosocial Dwarfism Follow-up
- Author: Andrew P Sirotnak, MD; Chief Editor: Caroly Pataki, MD more...
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
Patient education may vary depending on the developmental level or learning disability of the child when diagnosed.
For excellent patient education resources, visit eMedicine's Growth Hormone Deficiency Center. Also, see eMedicine's patient education articles Growth Failure in Children, Growth Hormone Deficiency, and Growth Hormone Deficiency FAQs.
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