We evaluated 201 children for short stature or delayed puberty or both. Fourteen of them (nine boys and five girls, aged 9 to 17 years) fit a pattern of growth failure due to malnutrition, which was the result of a self-imposed restriction of caloric intake arising from a fear of becoming obese. All 14 patients underwent a complete history, physical examination, diagnostic laboratory evaluation, and psychiatric assessment. They were all below the fifth percentile for weight, and 11 of them were also below the fifth percentile for height. The deficit of weight for height ranged from 5 to 23 per cent. Seven of the older patients also had delayed puberty. All 14 patients had deteriorating linear growth, which was preceded by at least one to two years of inadequate weight gain. They ingested only 32 to 91 per cent of the recommended caloric intake for their age and frequently skipped meals. No gross psychiatric disease or anorexia nervosa was found; on the whole, they were good students with rather compulsive, shy personalities observed in an open-ended interview. The Diagnostic Interview for Children and Adolescents, which was conducted with seven patients, also revealed no psychiatric disease. After nutritional and psychiatric counseling, the patients resumed an adequate caloric intake for their age, and recovery occurred, as demonstrated by increased linear growth and sexual development.
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