Psychosocial short stature

Psychosocial short stature (PSS) is a growth disorder that affects children between ages 2 and 15, triggered by severe emotional deprivation or ongoing stress. The condition involves reduced secretion of growth hormone and somatomedin, leading to very short stature, weight that does not match height, and a skeletal age that lags behind the child’s actual age. PSS primarily affects growth; while cognitive or developmental delays may occur in some cases, they are not a guaranteed or defining progressive feature. While rare in the general population, it appears often in feral children and those kept in abusive, confined settings for long periods. Growth slows or may temporarily cease, but the condition does not cause permanent growth cessation unless the stressor is never removed—once the stressor is removed, normal growth typically resumes.

**Cause** Children with PSS have very low growth hormone levels. This may stem from a problem with growth hormone inhibiting hormone (GHIH) or growth hormone releasing hormone (GHRH)—either the child does not respond to GHRH, or is overly sensitive to GHIH. These children show signs of failure to thrive: even with adequate nutrition, they do not grow or develop normally for their age. Constant, extreme stress is the root cause. Stress hormones like epinephrine and norepinephrine trigger the fight-or-flight response, speeding up the heart and diverting the body’s resources away from nonessential processes—including growth hormone production. Additionally, high levels of these hormones cause gastrointestinal issues, impairing nutrient digestion and further hindering development. A cure is uncertain, but some studies indicate that placing the child in a foster or group home can improve growth rate and social skills.

**Society and culture** In one case, a child admitted to a hospital with an extremely low weight was cared for by a nurse. Under her care, he gained weight quickly and his growth hormone levels rose. He became so emotionally dependent on her that when she left, his levels dropped back to admission levels; when she returned, they stabilized again. During a 1987 police raid that freed children from an Australian group called The Family, a twelve-year-old girl was found severely underweight and short for her age.