Psychosocially conditioned stunted growth masked as growth hormone deficiency

Short stature is a common reason for presenting a child to the pediatrician . Emotional deprivation may cause short stature and may simulate growth hor mone deficiency. Diagnosis of emotional deprivation as the cause of growth retardation is difficult and misdiagnosed frequently despite of suspicious clinical signs. We report on 2 patients with growth retardation because of emotional depriv ation. At the age of 5 years both children had a severe growth hormone defi ciency. They recieved therapy with growth hormone and showed an increase of growth velocity to greater than or equal to 8 cm in the first year of trea tment. But in the third year of treatment both patients showed a diminished response to the growth hormone therapy. During the period of observation t he features of emotional deprivation became obvious through the extreme beh avioural abnormalities. Both children showed disturbances in their social b ehaviour, and striking disorders concerning eating and digestion. The famil ies of these children had severe social problems; alcoholism, low income an d rejection of the child were risk factors. Removal from the current enviro nment led to a characteristic increase of the growth velocity. Growth hormo ne deficiency was spontanously reversible, so that treatment with growth ho rmone was terminated. The social environment and the psychical prosperity are essential growth fa ctors in childhood and adolescence. The common features and risk factors of emotional deprivation are described. Spontaneous catch-up growth after rem oval from the current environment distinguishes this form of short stature from the other organic growth disorders.