Recognition of children with psychosocial short stature: a spectrum of presentation.
We describe 65 children (32F, 33M) with psychosocial short stature from 51 families. Average age was 6.6 years (range 0.9-16.5) and all but five were prepubertal. 67% of the patients lived in families with three or more children, but in 73% of cases the patient was the first or the second born child. 45% of the parents were divorced and in 31% of the families the father was unemployed. In 56 children, the birth weight was known and in only 29% was it above 3000 g; 21% were premature, 29% had features of low birth-weight syndrome (including four with Russell-Silver syndrome). Average birth weight was 2786 g (range 1650-4676). In all patients, the predominant reason for referral was growth failure. In 28% an environmental aetiology was suspected and in a further 29%, social or emotional problems were known to the referring physician but not suspected as the aetiology of the growth failure, despite social services involvement in 60% at the referral to our unit. At initial presentation in our clinic, we found additional features leading to the suspicion of psychosocial short stature; 54% abnormal eating pattern, 42% behaviour problems, 26% encopresis, 18% nocturnal enuresis and 12% inappropriate urination. During the observation period of a mean of 3.7 years, 27 (41%) of our patients were found to have been sexually or physically abused. In these 27 children hyperphagia, bizarre eating habits, behaviour problems, soiling and nocturnal enuresis were more common.
Great Ormond Street Hospital for Children, Institute of Child Health, London, UK.
B C
BC
Gohlke
V V
VV
Khadilkar
D
D
Skuse
R
R
Stanhope
D000223:Adaptation, Psychological; D000293:Adolescent; D000886:Anthropometry; D001827:Body Height / Q000187:drug effects / Q000502:physiology*; D002648:Child; D002652:Child Behavior; D002675:Child, Preschool; D005260:Female; D006130:Growth Disorders / Q000188:drug therapy / Q000523:psychology*; D019382:Human Growth Hormone / Q000172:deficiency / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D008297:Male; D002666:Psychology, Child; D011610:Psychosocial Deprivation; D012959:Socioeconomic Factors
D019382:Human Growth Hormone