1/2. Transient diplegia in children who fail to thrive.We describe a group of eight children seen over a 4-year period. After a few months of apparently normal health and development, the children developed feeding difficulty, failed to thrive and had mild diplegia. No other underlying pathology was demonstrated. After a period of careful attention to feeding in the stimulating environment of a child development centre, the feeding difficulty, developmental delay and diplegia all disappeared, but, by school age, the children showed learning or behavioural difficulty. It is suggested that these children suffered a subtle neurological insult during the intra-uterine period and that this predisposed them to the neurological difficulty and failure to thrive. It is important to distinguish this small group of children from those in whom non-organic failure to thrive is found and parental neglect is suspected.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
2/2. Reversible growth failure among Hispanic children: instances of psychosocial short stature.OBJECTIVE: Psychosocial short stature (PSS), is the only known variant of reversible growth hormone deficiency (GHD)-like state. Herein we present three cases of Puerto Rican children with PSS, which will aid the uninitiated to the entity and assist in making the appropriate diagnosis. All of them demonstrated catch up growth and reversible GHD state as determined by increased insulin-like growth factor 1 (IGF-1) production and growth hormone secretion after pharmacologic stimulation. methods: Three boys ages 4.5 to 15.5 years were evaluated because of poor growth at the University Pediatric Hospital in San Juan, puerto rico. Medical evaluation excluded organic causes for growth failure. Psychosocial evaluation revealed the presence of repeated instances of psychological abuse by caretakers and the subjects demonstrated patterns of bizarre behavior. These findings prompted evaluation toward the possibility of PSS. The three children were removed from their caretakers' homes and placed in foster nurturing environments. RESULTS: Once relocated, the three children were able to demonstrate marked weight gain, growth acceleration, and improved social behavior. These changes were accompanied by biochemical evidence of GH-axis recovery as determined by the augmented insulin-like growth factor 1 levels and GH secretion. They have continued thriving at their foster homes. These results were felt to be compatible with PSS Type 2. CONCLUSION: We conclude that infants and children with growth failure without apparent organic cause, should be suspected of having PSS. Early relocation is critical for a successful outcome.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |