Child Abuse and Neglect, Psychosocial Dwarfism Treatment & Management

  • Author: Andrew P Sirotnak, MD; Chief Editor: Caroly Pataki, MD   more...
 
Updated: Mar 11, 2010
 

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.

Growth curves of 5 children with psychosocial shorGrowth 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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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.
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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.

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Activity

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

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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.

Specialty Editor Board

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.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

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, Keck School of Medicine of the University of Southern California

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.

References

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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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