eMedicine Specialties > Pediatrics: Developmental and Behavioral > Medical Topics
Child Abuse & Neglect: Psychosocial Dwarfism: Treatment & Medication
Updated: Mar 19, 2008
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
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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Tarren-Sweeney M. Patterns of aberrant eating among pre-adolescent children in foster care. J Abnorm Child Psychol. Oct 2006;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). May 1994;40(5):687-92. [Medline].
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Gloebl HJ, Capitanio MA, Kirkpatrick JA. Radiographic findings in children with psychosocial dwarfism. Pediatr Radiol. Feb 13 1976;4(2):83-6. [Medline].
Blizzard RM, Bulatovic A. Syndromes of psychosocial short stature. In: Pediatric Endocrinology. 1996:83-93.
Fazil Q. Dwarfism: Medical and psychosocial aspects of profound short stature. Psychiatr Bulliten [serial online]. 2006;30:Accessed October 10, 2007. Available at http://pb.rcpsych.org/cgi/content/long/30/11/439.
Green WH, Campbell M, David R. Psychosocial dwarfism: a critical review of the evidence. J Am Acad Child Psychiatry. Jan 1984;23(1):39-48. [Medline].
Inokuchi M, Hasegawa T. [Deprivation dwarfism]. Nippon Rinsho. May 28 2006;Suppl 1:102-4. [Medline].
Lifshitz F, Tarim O, Smith MM. Nutritional growth retardation. In: Pediatric Endocrinology. 3rd ed. 1996:103-20.
Northam EA. Neuropsychological and psychosocial correlates of endocrine and metabolic disorders--areview. J Pediatr Endocrinol Metab. Jan 2004;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. In: 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. Jan 1994;15(1):39, 41. [Medline].
Further Reading
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
Treatment & Medication: Child Abuse & Neglect: Psychosocial Dwarfism