Psychosocial Short Stature

Updated: Oct 02, 2023
  • Author: Andrew P Sirotnak, MD; Chief Editor: Caroly Pataki, MD  more...
  • Print

Practice Essentials

Psychosocial short stature (PSS) is a disorder of short stature or growth failure and/or delayed puberty of infancy, childhood, and adolescence that is observed in association with emotional deprivation, a pathologic psychosocial environment, or both. A disturbed relationship between child and caregiver is usually noted. [1]

Signs and symptoms

Physical examination of the infant or child with PSS reveals short stature; height less than the third percentile for chronologic age of the child is the most common and important physical examination finding of PSS.


Order baseline screening for FTT to exclude common organic causes of growth failure. In PSS, results of these tests are within the reference ranges. 

Diagnosis of PSS is confirmed by the removal of the child from the unsafe or nonnurturing environment and observation of the following with time: [2]

  • Demonstration of catch-up growth

  • Improvements in behaviors

  • Normalization of hormonal disturbances


The primary purpose of inpatient evaluation of children with PSS is providing an emergently needed safe environment.

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.



Psychosocial short stature (PSS) is a disorder of short stature or growth failure and/or delayed puberty of infancy, childhood, and adolescence that is observed in association with emotional deprivation, a pathologic psychosocial environment, or both. A disturbed relationship between child and caregiver is usually noted. [1] A number of pediatric endocrinologists have studied and categorized several generally accepted subtypes; these clinicians also have described therapeutic interventions for children with PSS.

The following 3 subtypes are described, based on the patient's age at presentation and the clinical findings:

  • In type I PSS, the age of onset is infancy. Usually, failure to thrive (FTT) is present, but no bizarre behaviors are observed. Patients are often depressed. Normal growth hormone (GH) secretion is found, but responsiveness to GH is unknown. No history of parental rejection is present in type I PSS.

  • In type II PSS, the age of onset is 3 years or older. Some of these patients have FTT. Bizarre behaviors are usually observed, and patients are often depressed. Decreased or absent GH secretion is found with minimal responsiveness to GH. A history of parental rejection or pathology is present. [3]

  • In type III PSS, the age of onset is in infancy or older. FTT is not usually present, and bizarre behavior is not usually observed. GH secretion is normal; responsiveness to GH is significant. No history of parental rejection is present.



The pathophysiology of PSS is complex, involving some nutritional factors and a heterogenous endocrine dysfunction; however, the pathophysiology mostly involves psychological and environmental pathology, affecting the growth and development of the child. Endocrine disturbances of GH, secondary thyroid dysfunction, and somatomedin C (Sm-C) levels are reported in persons with type II PSS. Linear growth is obviously delayed. Growth arrest lines are observed in long bones, and temporary widening of cranial sutures has been reported. Sleep disturbance and pain agnosia are observed. Sequelae in higher cognitive and other psychological functions have been described in adults with a history of this disorder. Some recent neuroendocrine research has been focused on the relationship of environmental stress on growth. [4, 5]




Psychosocial short stature is so rare a form of growth failure related to severe abuse or neglect that there is no epidemiological data available on the actual incidence.


Mortality rates are unknown. Because this is a form of severe child neglect, morbidity can be considered present in all children diagnosed with PSS. Therefore, the rate and severity of morbidity relates to the chronic nature of the deprivation, time of diagnosis, subsequent placement into a nurturing environment, and, finally, the long-term follow-up care while living in a secure and nurturing environment.


All races are affected by child neglect; however, literature and early studies report that most cases of PSS occur in Caucasians.

Increased occurrence in males has been suggested only by anecdotal reports.

The age of onset for type I PSS is infancy. The onset of type II PSS is in children aged 3 years or older. The onset in type III PSS occurs in infancy or later in childhood.



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.


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.