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.
Gohlke
B C
BC
Great Ormond Street Hospital for Children, Institute of Child Health, London, UK.
Khadilkar
V V
VV
Skuse
D
D
Stanhope
R
R
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