A Washington state couple is accused of physically abusing their five adopted children and starving them to the point where they were forced to eat pet food and weeds to survive.
According to local media reports, Jeffrey and Rebecca Trebilcock kept food under lock and key and severely beat the children if they tried to take some. The couple also has four biological children, but police say they are well-nourished.
Doctors who treated the children -- four girls and a boy, ages 8 to 13 -- say they were all underweight and neglected. Authorities say the 13-year-old boy was only 4-feet-4 and 49 pounds when he was removed from the home in March. Data from national growth charts show the average weight for a 13-year-old boy is about 100 pounds.
A doctor diagnosed the boy with psychosocial dwarfism, a growth disorder seen in children ages 2 to 15 caused by an emotionally deprived environment.
Experts not associated with this case say psychosocial dwarfism is rare. Depending on the ages of the children who have it, they can recover well if they are placed in a warm, loving environment.
"Treatment is removal from scenario and placing into nurturing environment," said Dr. Walter F. Lambert, director of the University of Miami Child Protection Team. "The trauma is treatable. Older children do much better than infants and toddlers because younger children's brains are still developing and can be injured."
The boy has reportedly already grown an inch and gained 25 pounds. The girls have also gained a healthy amount of weight since being placed in protective custody.
Psychosocial dwarfism is sometimes confused with what doctors call "failure to thrive." Failure to thrive exists when a child's weight or rate of weight gain is significantly lower than that of other children of the same age. Experts, however, say there are key differences.
"With psychosocial dwarfism, we're really looking at height, and failure to thrive refers to weight," said Dr. Deanna Aftab-Guy, a pediatric endocrinologist and assistant professor of pediatrics at the Children's Hospital at Vanderbilt in Nashville, Tenn.
Lambert says the difference is based on age. Failure to thrive occurs in young children while psychosocial dwarfism happens to school-age children. Both are caused by poor nutrition and an environment lacking in affection. Even if children are well-nourished, doctors say they can develop the disorder if they aren't nurtured.
"Some children have a hormonal dysfunction based on the fact they're not being tended to," said Lambert. "Because they're not nurtured, they don't grow." Normal hormonal cycles may be disrupted somehow, he said.
The exact mechanism that causes the disorder isn't clear.
"I doubt that they are growth hormone-deficient if children recover once they're removed from that environment," said Aftab-Guy.
Aftab-Guy said other conditions can affect children's growth, including celiac disease and certain cancers. A diagnosis of psychosocial dwarfism usually comes after ruling out other serious illnesses and assessing children's environment.
In addition to abnormal physical appearance, children with psychosocial dwarfism may exhibit what Lambert calls "animal-like behaviors," show little to no emotion and isolate themselves.
The Trebilcocks' neighbors and attorney told the local media the charges are false. They are charged with several counts of criminal mistreatment and felony assault. They posted bail and were released from jail on May 20.