Abuse Dwarfism-Reply

In Reply.—Starvation is undoubtedly a form of child abuse, but to place undue emphasis on it oversimplifies a very complex situation. For example, in the classical study by Widdowson¹ in which the nutritional intake of children in two European orphanages was carefully quantitated, the children in the abusing environment showed a striking improvement in weight gain when the harsh matron departed. The food ration available to them remained the same. Observations in middle-income and upper-income families indicate that growth failure may take place in environments that are nutritionally adequate but psychologically adverse.^2.3

Many years ago, I was asked to see in consultation the daughter of a wealthy family in another country. Evaluation of the medical findings and of the affective environment strongly suggested that the growth failure of this "poor little rich girl" was associated with psychosocial deprivation. Surrounded by servants and the accoutrements of affluence, it