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August 8, 1979


No. 1461 April Term, 1978, Appeal from the Order of the Court of Common Pleas of Westmoreland County, Juvenile Division No. 57 January Term, 1976


Marla R. Blum, Greensburg, for appellants.

Donald J. Snyder, Jr., Greensburg, for appellee.

James L. Liberto, New Kensington, for Westmoreland County Children's Bureau, participating party.

Cercone, President Judge, Wieand and Hoffman, JJ.

Author: Hoffman

[ 268 Pa. Super. Page 449]

Appellants are the natural parents of Tamela, a young child diagnosed a psychosocial dwarf. They contend that the lower court erred in: (1) declaring Tamela a "dependent child" under the Juvenile Act*fn1 and (2) ordering her placement in a home for crippled children until she attains a certain height. We affirm with modifications and remand with directions for further proceedings.

On August 8, 1978, the Westmoreland County Children's Bureau filed a petition alleging that Tamela, born November 3, 1969, was currently in a foster home and that two

[ 268 Pa. Super. Page 450]

    doctors had recommended that she return to her natural parents on a trial basis. On October 27, 1978, the lower court held a hearing on the petition at which Tamela and appellants were represented by separate counsel. The testimony adduced at the hearing may be summarized as follows:

Ms. Karen Kempert, Tamela's caseworker from the Children's Bureau, testified that sometime prior to November 1972, Tamela was hospitalized and found to be very small for her age and malnourished, with abnormal affect, an enlarged liver, and battered child syndrome. She was then placed in a foster home until November 1972. From November 1972 to January 1976, Tamela lived with her natural family. On January 13, 1976, Tamela entered a hospital where a Dr. Zeidner diagnosed her a psychosocial dwarf. At that time she behaved abnormally and was undersized and malnourished, with an enlarged liver and high blood cholesterol level. On January 16, 1976, the Children's Bureau obtained emergency custody of Tamela. On March 5, 1976, Tamela was discharged from the hospital and placed in a foster home. Approximately one week later, the Children's Bureau transferred her to another foster home where she continued to reside up to October 27, 1978, the day of the hearing. On May 8, 1976, appellants consented to the Children's Bureau's custody of Tamela. Appellants visited Tamela twice in September and October 1976 under Bureau supervision, at which time Tamela began to eat compulsively. Appellants stopped their visits and did not resume them until September 1977 upon the recommendation of Dr. Maria Von Mickwitz. By March 1978, Tamela was visiting with appellants overnight once a month and, by July 1978, twice a month. Tamela exhibited no adverse effects as a result of the visits. In fact, while she grew 1 1/4" during an 11 month period without parental visits, she grew 2 1/4" during the subsequent 11 month period with parental visits. Tamela did not grow during the two months immediately prior to the October 27, 1978 hearing; Kempert testified that Tamela was having problems both at the foster home and at school. Kempert further testified that appellants had voluntarily

[ 268 Pa. Super. Page 451]

    entered family therapy in January 1978 and had always been very cooperative.

Dr. Dorothy Becker, a pediatrician and endocrinologist with a special expertise in psychosocial dwarfism, next testified. According to Dr. Becker, psychosocial dwarfism is a relatively new diagnosis first identified in 1963 when children presented "what looked like clinical and chemical growth deficiency. These children were tested, were going to be put onto growth hormones and while awaiting therapy in a convalescent home were found to grow faster than any normal child, and it was later confirmed that children with certain specific history, family history, and certain specific physical features fitted this diagnosis which goes by a number of different names [including emotional deprivation].*fn2 These children have been found to have poor growth physically, and . . . mentally in their own home environment, and when they are removed from this home environment have spontaneous improvement in both physical, mental, and emotional development without any intervention medically, frequently without any psychological intervention. . . . [T]hese children seem to react to their environmental situation which is not necessarily one of deprivation. There is still not a consensus of opinion in the medical world . . . whether this syndrome is related to malnutrition. . . ." Dr. Becker testified that excessive stress on the children appears to cause certain biochemical changes, one of which is that the growth hormone "just switches off." Another classical feature of the syndrome is an abnormally high fat content in the blood. Dr. Becker agreed that a diagnosis of psychosocial dwarfism necessarily means that the home environment is unsatisfactory to the child and not adequate for the child's proper care.

Dr. Becker testified that in order to attain "anything near normal growth," either mental or physical, a child must grow faster than normal until he attains at least the minimum

[ 268 Pa. Super. Page 452]

    limit for normal. This faster growth is called "catch up growth." In her study of 35 children diagnosed psychosocial dwarves, Dr. Becker found that only 1 of the 35 attained any degree of catch up growth while in his own home. Of the remaining 34 children, none achieved or maintained catch up growth in the natural home despite psychological and psychiatric intervention. When placed in a foster home or similar setting, 5 children achieved catch up physical growth, and "most" experienced catch up mental growth. While all the children in the study under 10 years old caught up in growth, not all those over 10 years old did. When they reached the lowest limit of normal height for their age, the children returned to their natural home. There they maintained only normal growth despite psychological and other intervention.

Dr. Becker first saw Tamela sometime in 1976, twice again in the next 2 1/2 years, and most recently in August 1978. She has never seen appellants or Tamela's two brothers, nor has she ever read any psychological or psychiatric assessment of appellants. Dr. Becker testified, however, that she had reviewed data from Tamela's social worker, psychiatrist, and ...

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