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Child Abuse & Neglect: Psychosocial Dwarfism: Treatment & Medication

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

Updated: Mar 19, 2008

Treatment

Medical Care

Removing the child with psychosocial short stature (PSS) from the dangerous or nonnurturing environment is the critical intervention that must occur. This intervention, with appropriate mental health treatment (if needed), improves the abnormal behaviors often observed in individuals with type II PSS. Additional therapy may involve other medical and hormonal therapies, depending on the results of testing. Return to the previous environment has been demonstrated to result in rapid deceleration of the improved growth rate.

  • Addressing the psychosocial pathology in the child's environment must occur if returning the child to the previous caregiver is considered. Many such caregivers have their own histories of abuse, neglect, or both and may require intensive mental health therapy to be able to effectively parent.
  • In treating individuals with PSS, address any diagnosis of depression or other mood disorder. Therapy with child psychiatry or psychology may include medication.

Consultations

As in any chronic or complex pediatric disease, a multidisciplinary team approach is generally preferred.

  • Consult a pediatric endocrinologist when treating individuals with PSS because diagnostic testing and hormonal therapy may be indicated. A specialist best guides such therapy.
  • Involve mental health professionals to evaluate for comorbid diagnoses and to participate in treatment planning. Mental health consultation may be recommended for the caregivers and facilitated by the child's mental health consultant.
  • A social service evaluation of the family situation is mandatory.
  • A nutritionist can provide recommendations on dietary evaluation and treatment.
  • A child developmental specialist evaluation is valuable and aids in treatment plans.
  • A pediatric child abuse specialist familiar with the complexity of such cases can also help guide diagnosis and care.

Diet

A routine diet for age is appropriate. An evaluation by a nutritionist is helpful in any person with malnutrition. Such a consultant may recommend evaluation for vitamin and mineral deficiency.

Activity

Normal activity without restriction is appropriate unless a comorbid diagnosis prevents activity or the child with PSS needs more intensive supervision.

Medication

No routine drug therapy is indicated. Consult with a pediatric endocrinologist to guide therapy with replacement GH. A licensed mental health professional may recommend medication if required for a comorbid diagnosis.

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

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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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