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{{about|the medical condition|the legendary creature|dwarf|[[insular dwarfism]] and other uses|Dwarf (disambiguation)}}
{{DiseaseDisorder infobox |
 Name = Dwarfism |                  
 ICD10 = |
 ICD9 = {{ICD9|253.3}}, {{ICD9|259.4}} |
}}
'''Dwarfism''' refers to a condition of extreme small size of a person, animal, or plant. Any type of marked human smallness could be termed dwarfism in older popular and medical usage. The term as related to human beings (the major subject of this article) is often used to refer specifically to those forms of extreme shortness characterized by ''disproportion'' of body parts, typically due to an [[genetic disorder|inheritable disorder]] in bone or cartilage development. 

Forms of extreme shortness characterized by ''proportional'' body parts usually have a hormonal or nutritional cause. An example is [[growth hormone deficiency]], once known as "pituitary dwarfism". 

The Little People of America (LPA) defines dwarfism as a medical or genetic condition that usually results in an adult height of 4'10" (147 cm) or shorter.<ref name="LPA">{{cite web  | title = Dwarfism Resources: Frequently Asked Questions  | publisher = Little People of America  | date = [[2006]]-[[July 9|7-9]]  | url = http://www.lpaonline.org/resources_faq.html | archiveurl = http://web.archive.org/web/20060516011550/http://www.lpaonline.org/resources_faq.html | archivedate = 2007-07-12 | accessdate = 2006-11-14}}</ref>
{{Wiktionarypar2 |dwarf}}
==Types of dwarfism==
*[[rhizomelic]] = root, e.g. bones of upper arm or thigh
*[[mesomelic]] = middle, e.g. bones of forearm or lower leg
*[[acromelic]] = end, e.g. bones of hands and feet.

When the cause of dwarfism is understood, it may be classified according to one of hundreds of names, which are usually permutations of the following roots:
*'''chondro''' = of cartilage
*'''osteo''' = of bone
*'''spondylo''' = of the vertebrae
*'''plasia''' = form
*'''trophy''' = growth

Examples include [[achondroplasia]], [[osseous dysplasia]], [[chondrodystrophy]], and [[osteochondrodystrophy]].[http://www.wheelessonline.com/ortho/dwarfism_and_dysplasias]

The most recognizable and most common form of dwarfism is [[achondroplasia]], which produces rhizomelic short limbs, increased spinal curvature, and distortion of skull growth. It accounts for 70% of dwarfism cases. Other relatively common types include [[spondyloepiphyseal dysplasia congenita]] (SED), [[diastrophic dysplasia]], [[pseudoachondroplasia]], [[hypochondroplasia]], and [[osteogenesis imperfecta]] (OI). Severe shortness with skeletal distortion also occurs in several of the [[mucopolysaccharidosis|mucopolysaccharidoses]] and other [[lysosomal storage disease|storage diseases]].

The average adult height of male and females with dwarfism is 132cm and 123cm respectively. The average weight of an adult may range from 100 to 150 pounds (45-68 kg).

== Diagnosis ==
Unusually short stature for a child's age is usually what brings the child to medical attention. Skeletal [[dysplasia]] ("dwarfism") is usually suspected because of obvious physical features (e.g., unusual configuration of face or shape of skull), because of an obviously affected parent, or because body measurements (arm span, upper to lower segment ratio) indicate disproportion. Bone x-rays are often the key to diagnosis of a specific skeletal dysplasia, but they are not the key diagnosis. Most children with suspected skeletal dysplasias will be referred to a genetics clinic for diagnostic confirmation and [[genetic counselling]]. (See [[#External links|External links]], below, for a list of American referral centers with special expertise in skeletal dysplasias.) In the last decade, genetic tests for some of the specific disorders have become available.

During the initial medical evaluation for shortness, the absence of disproportion and the other clues above usually indicates other causes than bone dysplasias. Extreme shortness with completely normal proportions sometimes indicates [[growth hormone deficiency]] (''pituitary dwarfism).''

Short stature alone, in the absence of any other abnormalities, may simply be genetic, particularly if a person is born into a family of people who are relatively short.

== Problems associated with dwarfism ==
The principal adverse effects of dwarfism can be divided into the physical and the social.

Physical effects of malformed bones vary according to the specific disease. Many involve pain resulting from joint damage from abnormal bone alignment, or from [[nerve]] compression (e.g, [[spinal stenosis]]).<ref name="LPA"/>. Early degenerative joint disease, exaggerated [[lordosis]] or [[scoliosis]], and constriction of [[spinal cord]] or nerve roots can cause pain and disability. Reduced [[thorax|thoracic]] size can restrict lung growth and reduce pulmonary function. Some forms of dwarfism are associated with disordered function of other organs, such as the [[brain]] or [[liver]], sometimes severely enough to be more disabling than the abnormal bone growth.

The psychosocial disadvantages may be more distressing than the physical symptoms, especially in childhood and adolescence, but people with dwarfism vary greatly in the degree to which social participation and emotional health are affected.

* Social prejudice against extreme shortness may reduce social and marital opportunities. {{seealso|heightism}}
* Numerous studies have demonstrated reduced employment opportunities. Severe shortness is associated with lower income.
* [[Self-esteem]] may be reduced and family relationships affected
* Extreme shortness (in the low 2&ndash;3 foot [60&ndash;90&nbsp;cm] range) can interfere with ordinary activities of daily living, like driving or even using countertops built for taller people.
*Difficult to find nice clothes that fit

==Treatment and support==
As the genetic defects of most forms of dwarfism due to bone dysplasia cannot be corrected, therapeutic interventions are typically aimed at (1) preventing or reducing pain or physical disability, (2) increasing adult height, or (3) mitigating psychosocial stresses and enhancing social adaptation.  

Pain and disability may be ameliorated by physical therapy, by braces or other orthotic devices, or by surgical procedures.

The only simple interventions that increase perceived adult height are dress enhancements such as shoe lifts or hairstyle. Growth hormone is rarely used for shortness due to bone dysplasias, as the height benefit is typically small (less than 5 cm) and the cost high. The most effective means of increasing adult height by several inches is [[limb-lengthening surgery]], though availability is limited and cost is high in terms of dollars, discomfort, and interruption of life. Most people with dwarfism do not avail themselves of this, and it remains controversial.<ref name="LPA"/> For other types of dwarfism, surgical treatment is not possible.

== Dwarfism in non-Western cultures ==
In the [[Talmud]], it is said that the second born son of the [[Egypt]]ian [[Pharaoh]] of the [[Bible]] was a dwarf.<ref>[http://www.sacred-texts.com/jud/pol/pol09.htm The Talmud - CHAPTER VI. DEATH OF JACOB AND HIS SONS--MOSES--THE DELIVERANCE FROM EGYPT.] URL accessed [[April 23]], [[2007]]</ref>

== In popular culture and the arts ==
{{cleanup-laundry}}
[[image:velazquez-dwarf-don-sebastian-de-morra.jpg|right|thumb|''The Dwarf Don Sebastián de Morra'', by [[Velázquez]]. In his portraits of the dwarfs of Spain's royal court, the artist preferred a serious tone.]]
[[Image:Anthonis van Dyck 013.jpg|thumb|right|200px|"[[Queen Henrietta Maria]] and the dwarf [[Sir Jeffrey Hudson]]",by [[Anthonis van Dyck]], 1633]] 
When depicted in art, literature, or movies, dwarfs are rarely depicted as "regular people who are very short" but often as a species apart. [[Novelist]]s, [[artist]]s, and [[film-maker|moviemaker]]s attach special moral or aesthetic significance to the "apartness" or the misshapenness.

Artistic representations of dwarfism can be found on [[ancient Greece|Greek]] vases and other ancient artefacts, including [[ancient Egypt]]ian art. Documentation of dwarfs can also be found on European paintings and many pictures. Many [[Europe]]an paintings (especially [[Spain|Spanish]]) of the [[16th century|16th]]&ndash;[[19th century|19th]] centuries depict dwarfs by themselves or with others.

In [[Jonathan Swift]]'s "''[[Gulliver's Travels]]''", the protagonist encounters in the court of the Giants' Kingdom the strong enmity of the local "dwarf", who is "only" twenty feet high (where normal giants measure forty feet) and resents being displaced by "a smaller dwarf".   

Several novels have treated dwarfism as a major theme, although not necessarily realistically:
* ''[[The Tin Drum]]'' (''Die Blechtrommel'') by [[Günter Grass]]
* ''[[Stones from the River]]'' by [[Ursula Hegi]]
* ''[[The Dwarf]]'' by [[Pär Lagerkvist]]
* ''[[A Prayer for Owen Meany]]'' by [[John Irving]]
* ''[[A Son of the Circus]]'' by John Irving
* "[[Hop-Frog|Hop-Frog, or The Eight Chained Ourang-Outangs]]" by [[Edgar Allan Poe]]
* ''[[Maybe the Moon]]'' by [[Armistead Maupin]]
* ''[[Swords and Crowns and Rings]]'' by [[Ruth Park]]
* ''[[Tale of the Wind]]'' by [[Kay Nolte Smith]]
* ''[[Memoir of a Dwarf in the Sun King's Court]]'' by [[Paul Weidner]]
* ''[[The Eye of Night]]'' by [[Pauline Alama]]
* ''[[Mendel's Dwarf]]'' by [[Simon Mawer]] 
* ''[[Cat's Cradle]]'' by [[Kurt Vonnegut]]
* ''[[A Song of Ice and Fire]]'' by [[George R.R. Martin]]
[[Leslie Fiedler]]'s ''[[Freaks: Myths and Images of the Secret Self]]'' ([[1979]]) explored the value of differentness of "freaks" to "normal" people, lamenting medical treatment for reducing the number of picturesquely different people around. 

Several [[20th century|20th]] and [[21st century]] movies & TV shows have addressed the topic or made much use of dwarfs:
*''[[Freaks]]'' ([[1932]])
*''[[The Terror of Tiny Town]]'' ([[1938]])
*''[[The Wizard of Oz (1939 film)|The Wizard of Oz]]'' ([[1939]])
*''[[Even Dwarfs Started Small]]'' (''Auch Zwerge haben klein angefangen'') ([[1970]])
*''[[Willy Wonka & the Chocolate Factory]]'' (1971)
*''[[The Man With The Golden Gun (film)|The Man With The Golden Gun]]'' (1974)
*''[[Time Bandits]]'' ([[1981]])
*''[[Under the Rainbow]]'' ([[1981]])
*''[[Willow (film)|Willow]]'' ([[1988]])
*''[[Leprechaun (film)]]'' ([[1992]])
*''[[Austin Powers: The Spy Who Shagged Me]]'' ([[1999]])
*''[[Austin Powers in Goldmember]]'' ([[2002]])
*''[[Monster Garage]]'' (2002-2006)
*''[[Jackass: The Movie]]'' ([[2002]])
*''[[The Station Agent]]'' ([[2003]])
*''[[Tiptoes]]'' ([[2003]])
*''[[Little People, Big World]]'' (2006) – Reality TV series following the daily lives of a family with two dwarf parents and one dwarf child (as well as three other children of average height)
*''[[The Benchwarmers]]'' (2006)

The [[actor]] and [[stunt man]] [[Verne Troyer]] has become famous playing the character "[[Mini-Me]]" in two [[Austin Powers]] movies, as has fellow stuntman and ''[[Jackass (TV series)|Jackass]]'' cast-member, [[Jason Acuña|Jason "Wee-Man" Acuña]] .

The [[1960s]] [[television series]] ''[[The Wild Wild West]]'' featured a dwarf, [[Michael Dunn]], as the [[recurring character]] Dr. Miguelito Loveless, the brilliant but insane arch-enemy of [[United States Secret Service|Secret Service]] agents James West and Artemus Gordon.

In the mid-1970's, [[Sid and Marty Krofft]] built an indoor [[theme park]] in [[Atlanta, Georgia]] called [[The World of Sid and Marty Krofft]]. This had a live stage production that was at that time the largest gathering of "little people" since the filming of ''[[The Wizard of Oz (1939 movie)|The Wizard of Oz]]'' in 1937-38 as well as being the largest indoor theme park built to that time. The facility that was built to house this theme park is today the studios of [[CNN]], the [[Cable News Network]], and ''[[Headline News|CNN Headline News]]''.

In the [[1990s]], the immensely popular series ''[[Seinfeld]]'' featured a dwarf character, [[Mickey Abbott]], in seven episodes; Mickey was played by actor [[Danny Woodburn]]. He once got into a fight with six-foot-plus Kramer. In one episode, he was ostricized by his dwarf peers for using lifts in his shoes to make him look taller.   

From [[1999]] until [[2003]], the popular television series ''[[The Man Show]]'' featured dwarfs in many of their segments. They once claimed to be "the world's largest employer of midgets".

In ''[[Mind of Mencia]]'', one of the main characters is a dwarf named [[Brad Williams (comedian)|Brad Williams]]. Brad is a comedian who tours with [[Carlos Mencia]] as his opening act. 

In ''[[Monster Garage]]'', [[Chris "Body Drop" Artiaga]] made his début as a contestant in episode 'Ramp Rage', but later became parts runner for the series.  In addition, there are 2 episodes featuring all-dwarf build teams.

In [[George R.R. Martin]]'s ''[[A Song of Ice and Fire]]'' series, one of the main characters, [[Tyrion Lannister]], is a dwarf. Though a brilliant and well-read man (some would say genius), he struggles with acceptance by "normal" people, who pejoratively refer to him as "the Imp," or "half-man". This is especially true of his father, Lord [[Tywin Lannister]], who holds Tyrion in contempt, especially when compared to Tyrion's handsome, talented older brother Jaime, and Jaime's equally beautiful and talented twin sister, Cersei. Tyrion often wonders if any woman could ever truly love him in spite of his condition.

[[Johnny Roventini]] was a dwarf bellboy in a [[New York City]] hotel when he was paid $1 to "Call for Phillip Morris", unknowingly beginning his 40-year career as an advertising icon in radio, television, and print media.

== See also ==
* [[Achondroplasia]]
* [[Chondrodystrophy]]
* [[List of people with dwarfism]]
* [[Primordial dwarfism]]
* [[Psychogenic dwarfism]]
* [[Gigantism]]
* [[Insular dwarfism]]
* [[Laron syndrome]]


==References==
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== External links ==
* [http://www.livinglittlemag.com/ Living Little Magazine]
* [http://www.wheelessonline.com Wheeless Textbook of Orthopedics online] has general medical information about various disorders of cartilage and bone formation
* [http://www.lpaonline.org/ Little People of America]
* [http://www.restrictedgrowth.co.uk/ Restricted Growth Association UK]
* [http://www.shortsupport.org www.shortsupport.org] for a variety of information related to short stature, and a somewhat cautionary view of [[limb lengthening surgery]].
* [http://www.littlepeoplethebook.com <I>Little People: A Father Reflects on His Daughter's Dwarfism -- and What It Means to Be Different</I>] by Dan Kennedy. Free Web edition of a critically acclaimed memoir.
* [http://www.garyparker.com/fmsetgallery.html?gallery=Dwarfism Photo Gallery of Little People]
[http://blogsmonroe.com/disability Raising a child with Achondroplasia, a form of dwarfism]⏎
About|the medical condition|the legendary creature|Dwarf (disambiguation)|[[insular dwarfism]] and other uses|Dwarf (disambiguation)}}
{{Infobox Disease
 | Name = Dwarfism
 | Image = Thomas_Dilward_-_Brady-Handy.jpg
 | Caption = A man with what appears to be a form of SED (Spondyloepiphyseal Dysplasia). His fingers are similar in size to those of a person of normal height. One of the symptoms is a set of characteristic facial features.
 | DiseasesDB     = 80
 | ICD10 = {{ICD10|E|23|0|e|20}}, {{ICD10|E|34|2|e|20}}, {{ICD10|E|45|0|e|40}}, {{ICD10|Q|77|4|q|65}}
 | ICD9 = {{ICD9|253.3}}, {{ICD9|259.4}}
 | ICDO           =
 | OMIM           =
 | MedlinePlus    = 001176
 | eMedicineSubj  =
 | eMedicineTopic =
 | MeshID         = D004392
}}

[[Image:velazquez-dwarf-don-sebastian-de-morra.jpg|right|thumb|''The Dwarf Don Sebastián de Morra'', by [[Diego Velázquez|Velázquez]].]]

[[File:Seneb and wife statue.jpg|right|thumb| Seneb, dwarf priest of funerary cults in [[4th Dynasty]] (c. 2640-2510 BCE) [[Ancient Egypt]], with his wife Senetites and their children.<ref>"''Ancient Egypt:Kingdom of the Pharaohs''", R. Hamilton, p. 47, Paragon, 2006, ISBN 1-4054-8288-5</ref>]]

'''Dwarfism''' ({{pron-en|ˈdwɔrfɪzəm}}) is short stature resulting from a particular medical condition. It is sometimes defined as an adult height of less than 4 feet 10&nbsp;inches (147&nbsp;cm),<ref name="urlMedlinePlus: Dwarfism">{{cite web |url=http://www.nlm.nih.gov/medlineplus/dwarfism.html |title=MedlinePlus: Dwarfism |date=2008-08-04|publisher=National Institute of Health|work=MedlinePlus |accessdate=2008-10-03}}</ref> although this definition is problematic because short stature in itself is not a disorder.

Dwarfism can be caused by about 200 distinct medical conditions,<ref name="urlDwarfism" /> such that the symptoms and characteristics of individual people with dwarfism vary greatly. In the [[United States]] and [[Canada]], many people with dwarfism prefer to be called '''little people'''.<ref name="LPA">{{cite web  | title = Dwarfism Resources: Frequently Asked Questions  | publisher = Little People of America  | date = 2006-07-09  | url = http://www.lpaonline.org/resources_faq.html | archiveurl = http://web.archive.org/web/20060516011550/http://www.lpaonline.org/resources_faq.html | archivedate = 2007-07-12 | accessdate = 2006-11-14 }}</ref>

''Disproportionate'' dwarfism is characterized by one or more body parts' being relatively large or small in comparison to those of a normal adult, with growth abnormalities in specific areas being apparent. In cases of ''proportionate'' dwarfism, the body appears normally proportioned, but is abnormally small. Historically, the term '''midget''' was used to describe "proportionate dwarfs"; however, this term has now become offensive and [[pejorative]] ''(see [[Dwarfism#Terminology|terminology]])''. [[Hypotonia]], or a lack of muscle, is common in dwarfs, but intelligence and lifespan are usually normal.

[[Achondroplasia]] is a bone-growth disorder responsible for 70% of dwarfism cases.<ref name="urlMedlinePlus: Dwarfism" /> In achondroplasia, the limbs are disproportionally short compared to the trunk (abdominal area), with the head larger than normal and characteristic facial features. Conditions in humans characterized by disproportional body parts are typically caused by one or more [[genetic disorder]]s in bone or cartilage development. Extreme shortness in humans with proportional body parts usually has a hormonal cause, such as [[Growth hormone deficiency|growth-hormone deficiency]], once called ''pituitary dwarfism''.<ref name="LPA" /><ref name='dwarfism-pbshome'>{{cite web |url=http://www.pbs.org/pov/pov2005/bigenough/special_dwarfism_ety.html |title=P.O.V. - Big Enough. What is Dwarfism? |accessdate=2008-11-18 |last=Kennedy |first=Dan |publisher=Public Broadcasting Service }}</ref>

There is no single treatment for dwarfism. Individual abnormalities, such as bone-growth disorders, sometimes can be treated through surgery, and some hormone disorders can be treated through medication, but usually it is impossible to treat all the symptoms of dwarfism. Lifestyle changes often are needed to cope with the effects of dwarfism. Such devices as specialized furniture often help people with dwarfism to function normally.<ref name="pmid14671400">{{cite journal |author=Hagenäs L, Hertel T |title=Skeletal dysplasia, growth hormone treatment and body proportion: comparison with other syndromic and non-syndromic short children |journal=Horm. Res. |volume=60 Suppl 3 |issue= |pages=65–70 |year=2003 |pmid=14671400 |doi=10.1159/000074504 |url=http://content.karger.com/produktedb/produkte.asp?typ=fulltext&file=HRE2003060S03065 |accessdate=2008-11-17}}</ref> Many support groups help sufferers of dwarfism cope with the challenges they face and with developing and maintaining their independence.<ref name='mayo-treatment'>{{cite web |url=http://www.mayoclinic.com/health/dwarfism/DS01012/DSECTION=treatments-and-drugs |title=Dwarfism: Treatment and drugs |accessdate=2008-11-18 |date=2007-09-27 |work=MayoClinic.com |publisher=Mayo Foundation for Medical Education and Research }}</ref>

Dwarfism is a highly visible condition and often carries negative connotations in society. Because of their unusual height, people with dwarfism are often used as spectacles in entertainment and portrayed with stereotypes. For a person with dwarfism, [[heightism]] can lead to ridicule in childhood and discrimination in adulthood.<ref name="UPenn">[http://www.ssc.upenn.edu/~persico/research/Papers/short.pdf University of Pennsylvania, Arts and Sciences: "The Effect of Adolescent Experience on Labor Market Outcomes: The Case of Height"].</ref><ref name="ScienceBlog">[http://www.scienceblog.com/community/older/2000/A/200000988.html Science Blog: "Short children more likely to be bullied at school"].</ref>

Short stature can be inherited without any coexisting disease. Short stature in the absence of any abnormal medical condition is not generally considered dwarfism. For example, a short man and a short woman who are in normal health will tend to produce children who are also short and in normal health. While short parents tend to produce short children, persons with dwarfism may produce children of normal height, if the cause of their dwarfism is not genetically transmissible or if the individual does not pass on the genetic mutation.

==Classification==
Dwarfism is a medical disorder with the sole requirement being an adult height under 4 feet 10&nbsp;inches (147&nbsp;cm) and it is almost always classified as to the underlying condition that is the cause for the short stature. Dwarfism is not necessarily caused by disease or a genetic disorder; it can simply be a naturally occurring consequence of a person's genetics. If dwarfism is caused by a medical disorder, the person is referred to by the underlying diagnosed disorder. Disorders causing dwarfism are often classified by proportionality. Disproportionate dwarfism describes disorders that cause abnormal proportions of the body parts, while proportionate dwarfism results in a generally uniform stunting of the body.

Disorders that cause dwarfism may be classified according to one of hundreds of names, which are usually permutations of the following roots:
* location
** '''[[Rhizomelia|rhizomelic]]''' = root, e.g., bones of the upper arm or thigh
** '''mesomelic''' = middle, e.g., bones of the forearm or lower leg
** '''acromelic''' = end, e.g., bones of hands and feet.
** '''micromelic''' = entire limbs are shortened
* source
** '''chondro''' = of cartilage
** '''osteo''' = of bone
** '''spondylo''' = of the vertebrae
** '''plasia''' = form
** '''trophy''' = growth

Examples include [[achondroplasia]], [[osseous dysplasia]], [[chondrodystrophy]], and [[osteochondrodystrophy]].<ref name="titleDwarfism and Dysplasias - Wheeless' Textbook of Orthopaedics">{{cite web |url=http://www.wheelessonline.com/ortho/dwarfism_and_dysplasias |title=Dwarfism and Dysplasias - Wheeless' Textbook of Orthopaedics |accessdate=2007-12-07 | date=2006-06|publisher=Duke Orthopaedics|format= |work=Wheeless' Textbook of Orthopaedics}}</ref>

==Characteristics==
A typical defining characteristic of dwarfism is an adult height of less than 1.47 m (4 feet 10&nbsp;inches). Since those with dwarfism have such a wide range of physical characteristics, oddities in individuals are identified by diagnosing and monitoring the underlying disorders.

Disproportionate dwarfism is characterized by one or more body parts being disproportionately large or small compared to the rest of the body. In [[achondroplasia]] the trunk is normally sized with the limbs being disproportionately short, the head being larger than usual, and the forehead being prominent.<ref name='dwarfism-pbshome'/> Facial features are often affected and individual body parts may have problems associated with them. Orthopedic problems can result from multiple conditions such as [[diastrophic dysplasia]] and [[pseudoachondroplasia]].

Proportionate dwarfism is marked by body parts being proportional but stunted.<ref name='mayo-symptoms'>{{cite web|url=http://www.mayoclinic.com/health/dwarfism/DS01012/DSECTION=symptoms |title=Dwarfism: Symptoms |accessdate=2009-01-29 |work=MayoClinic.com |publisher=Mayo Foundation for Medical Education and Research }}</ref> Height is significantly below average and there may be long periods without any significant growth. Sexual development is often delayed or impaired into adulthood. Unlike disproportionate dwarfism, mental capacity may be diminished in some cases of proportionate dwarfism. The overall stunted growth can lead to impaired intelligence when compared to the physical age.{{Citation needed|date=May 2010}}

Physical maleffects of malformed bones vary according to the specific disease. Many involve joint pain caused by abnormal bone alignment, or from [[nerve]] compression (e.g., [[spinal stenosis]]).<ref name="LPA"/> Early degenerative joint disease, exaggerated [[lordosis]] or [[scoliosis]], and constriction of [[spinal cord]] or nerve roots can cause pain and disability.<ref name='seattle-dysplasia'>{{cite web|url=http://orthopedics.seattlechildrens.org/conditions_treated/dwarfism_and_bone_dysplasias.asp |title=Dwarfism and Bone Dysplasias |accessdate=2008-11-18 |publisher=Seattle Children's Hospital, Research & Foundation }}</ref> Reduced [[thorax|thoracic]] size can restrict lung growth and reduce pulmonary function. Some forms of dwarfism are associated with disordered function of other organs, such as the [[brain]] or [[liver]], sometimes severely enough to be more disabling than the abnormal bone growth.<ref name='mayo-complications'>{{cite web|url=http://www.mayoclinic.com/health/dwarfism/DS01012/DSECTION=complications |title=Dwarfism: Complications |accessdate=2008-11-18 |work=MayoClinic.com |publisher=Mayo Foundation for Medical Education and Research }}</ref><ref name="pmid5946547">{{cite journal |author=Escamilla RF, Hutchings JJ, Li CH, Forsham P |title=Achondroplastic dwarfism. Effects of treatment with human growth hormone |journal=Calif Med |volume=105 |issue=2 |pages=104–10 |year=1966 |month=August |pmid=5946547 |pmc=1516352 |doi= |url= |accessdate=2008-11-17}}</ref>

Mental effects also vary according to the specific underlying syndrome. In most cases of skeletal dysplasia, such as achondroplasia, mental function is not impaired in any way.<ref name='mayo-symptoms'/> However, there are syndromes which can affect the cranial structure and growth of the brain, severely impairing mental capacity. Unless the brain is directly affected by the underlying disorder, there is little to no chance of mental impairment that can be attributed to dwarfism.<ref name="urlThe Pituitary Gland & Growth Disorders: An Overview">{{cite web |url=http://www.hormone.org/Growth/overview.cfm |title=The Pituitary Gland & Growth Disorders: An Overview |format= |work= |accessdate=2009-02-22}}</ref>

The psychosocial disadvantages may be more distressing than the physical symptoms, especially in childhood and adolescence, but people with dwarfism vary greatly in the degree to which social participation and emotional health are affected.

* Social prejudice against extreme shortness may reduce social and marital opportunities.<ref name="isbn 0-8018-8121-8">{{cite book |author=Hall, Judith A.; BETTY M. ADELSON |title=Dwarfism: medical and psychosocial aspects of profound short stature |publisher=Johns Hopkins University Press |location=Baltimore |year=2005 |pages= |isbn=0-8018-8121-8 |oclc= |doi= |accessdate=}}</ref><ref name="pmid12884421">{{cite journal |author=Gollust SE, Thompson RE, Gooding HC, Biesecker BB |title=Living with achondroplasia in an average-sized world: an assessment of quality of life |journal=American journal of medical genetics. Part A |volume=120A |issue=4 |pages=447–58 |year=2003 |month=August |pmid=12884421 |doi=10.1002/ajmg.a.20127}}</ref> {{See also|heightism}}
* Numerous studies have demonstrated reduced employment opportunities. Severe shortness is associated with lower income.<ref name="pmid12884421" />
* [[Self-esteem]] may suffer and family relationships may be affected.
* Extreme shortness (in the low 2&ndash;3 foot [60–90&nbsp;cm] range) can interfere with ordinary activities of daily living, like driving or using countertops built for taller people. Other symptoms of dwarfism such as bowed knees and unusually short fingers can lead to back problems, difficulty in walking, and handling objects.
* Children with dwarfism are particularly vulnerable to teasing and ridicule from classmates. Because dwarfism is relatively uncommon, children may feel isolated from their peers.<ref name='mayo-complications'/>

==Causes==
Dwarfism can result from myriad medical conditions, each with its own separate symptoms and causes. Two disorders, achondroplasia and growth hormone deficiency (also known as pituitary dwarfism), are responsible for the majority of dwarfism cases.<ref name="urlDwarfism">{{cite web |url=http://kidshealth.org/parent/growth/growth/dwarfism.html |title=Dwarfism |work= |accessdate=2009-02-22}}</ref>

===Achondroplasia===
{{Further|[[Achondroplasia]]}}
The most recognizable and most common form of dwarfism is [[achondroplasia]], which accounts for 70% of dwarfism cases and produces rhizomelic short limbs, increased spinal curvature, and distortion of skull growth. Achondroplasia is an [[autosomal dominant]] disorder caused by the presence of a faulty [[allele]] in a person's genome. If a pair of achondroplasia alleles are present, the result is fatal. Achondroplasia is a mutation in the [[fibroblast]] [[growth factor]] [[receptor (biochemistry)|receptor]] gene 3 ({{Gene|FGFR3}}), which is an inhibitor that regulates bone growth. In cases of achondroplasia, the FGR3 gene is too aggressive, negatively impacting bone growth.<ref name="urlAchondroplasia - Genetics Home Reference">{{cite web |url=http://ghr.nlm.nih.gov/condition=achondroplasia |title=Achondroplasia - Genetics Home Reference |date=2008-09-26|format= |work=Genetics Home Reference|publisher=National Institute of Health |accessdate=2008-10-01}}</ref>

Research by urologist Harry Fisch of the Male Reproductive Center at Columbia Presbyterian Hospital indicates that this defect may be exclusively inherited from the father and becomes increasingly probable with paternal age; specifically males reproducing after 35.  <ref>The Male Biological Clock by Harry Fisch</ref>

===Growth hormone deficiency===
{{Further|[[Growth hormone deficiency]]}}
Growth hormone deficiency (GHD) is a medical condition in which the body produces insufficient [[growth hormone]]. Growth hormone, also called [[somatotropin]], is a [[polypeptide]] [[hormone]] which stimulates [[Human development (biology)|growth]] and cell reproduction. If this hormone is lacking, stunted or even halted growth may become apparent. Children with this disorder may grow slowly and puberty may be delayed by several years, or even indefinitely. Growth hormone deficiency has no single definite cause. It can be caused by mutations of specific genes, damage to the pituitary gland, [[Turner's syndrome]], poor nutrition,<ref name='ghdeficiency'>{{cite web | publisher = UK Child Growth Foundation | title=Growth Hormone Deficiency |url=http://www.childgrowthfoundation.org/ghd.htm | accessdate=2009-01-16}}</ref> or even stress (leading to [[psychogenic dwarfism]]).

===Other===
Other causes of dwarfism include [[spondyloepiphyseal dysplasia congenita]], [[diastrophic dysplasia]], [[pseudoachondroplasia]], [[hypochondroplasia]], [[Noonan syndrome]], [[primordial dwarfism]], [[Turner syndrome]], [[osteogenesis imperfecta]] (OI) and [[hypothyroidism]]. Severe shortness with skeletal distortion also occurs in several of the [[Mucopolysaccharidosis|Mucopolysaccharidoses]] and other [[lysosomal storage disease|storage disorders]].<ref name="urlCauses of Dwarfism - WrongDiagnosis.com">{{cite web |url=http://www.wrongdiagnosis.com/d/dwarfism/causes.htm |title=Causes of Dwarfism - WrongDiagnosis.com |work= |accessdate=2009-03-23}}</ref>

Serious chronic illnesses may produce dwarfism as a side effect. Harsh environmental conditions, such as malnutrition, may also produce dwarfism. These types of dwarfism are indirect consequences of the generally unhealthy or malnourished condition of the individual, and not by any specific disease. The dwarfism often takes the form of simple short stature, without any deformities. In societies where poor nutrition is widespread, the average height of the population may be reduced below its genetic potential by the lack of proper nutrition.

==Diagnosis==
Dwarfism is often diagnosed in childhood on the basis of visible symptoms. A  physical examination can usually suffice to diagnose certain types of dwarfism, but [[genetic testing]] and diagnostic imaging may be used to determine the exact condition.<ref name="urlDWARFISM (Algorithmic Diagnosis of Symptoms and Signs) - WrongDiagnosis.com">{{cite web |url=http://www.wrongdiagnosis.com/d/dwarfism/book-diseases-1a.htm |title=DWARFISM (Algorithmic Diagnosis of Symptoms and Signs) - WrongDiagnosis.com |work= |accessdate=2009-02-22}}</ref> In a person's youth, growth charts that track height can be used to diagnose subtle forms of dwarfism that have no other striking physical characteristics.<ref name="urlDwarfism"/>

Short stature or stunted growth during youth is usually what brings the condition to medical attention. Skeletal [[dysplasia]] is usually suspected because of obvious physical features (e.g., unusual configuration of face or shape of skull), because of an obviously affected parent, or because body measurements (arm span, upper to lower segment ratio) indicate disproportion.<ref name="urlDWARFISM (Algorithmic Diagnosis of Symptoms and Signs) - WrongDiagnosis.com"/> Bone X-rays are often key to diagnosing a specific skeletal dysplasia, but are not the sole diagnostic tool. Most children with suspected skeletal dysplasias are referred to a genetics clinic for diagnostic confirmation and [[genetic counseling]]. Since about the year 2000, genetic tests for some of the specific disorders have become available.<ref name='mayo-diagnosis'>{{cite web|url=http://www.mayoclinic.com/health/dwarfism/DS01012/DSECTION=tests-and-diagnosis |title=Dwarfism: Tests and diagnosis |accessdate=2008-11-18 |date=2007-08-27 |work=Mayo Clinic |publisher=Mayo Foundation for Medical Education and Research }}</ref>

During an initial medical evaluation of shortness, the absence of disproportion and other clues listed above usually indicates causes other than bone dysplasias. Extreme shortness with completely normal proportions sometimes indicates [[growth hormone deficiency]] (pituitary dwarfism).<ref name='ghd-diagnosis'>{{cite web|url=http://www.emedicine.com/PED/topic1810.htm |title=eMedicine - Growth Hormone Deficiency : Article by Stephen Kemp |accessdate=2008-11-18 |last=Kemp |first=Stephen |date=2008-09-15 |work=eMedicine |publisher=WebMD, Inc. }}</ref>

Short stature alone, in the absence of any other abnormalities, may be the result of the distribution of offspring height from short-statured parents, rather than a symptom of any medical condition.<ref name='short-stature-norm'>{{cite web|url=http://www.emedicinehealth.com/short_stature_in_children/article_em.htm |title=Short Stature in Children |accessdate=2008-11-18 |work=eMedicineHealth.com |publisher=WebMD, Inc. }}</ref>

==Prevention==
Many types of dwarfism are impossible to prevent because they are genetically caused. Genetic conditions that cause dwarfism may be identified with [[genetic testing]], by screening for the specific abnormalities that result in the condition. However, due to the number of causes of dwarfism, it may be impossible to determine definitively if a child will be born with dwarfism.

Dwarfism resulting from malnutrition or a hormonal abnormality may be treated with an appropriate diet or hormonal therapy. Growth hormone deficiency may be remedied via injections of [[Growth hormone treatment|Human Growth Hormone (HGH)]] during early life.

==Management==
Genetic defects of most forms of dwarfism caused by bone dysplasia cannot be corrected, so therapeutic interventions are typically aimed at preventing or reducing pain or physical disability, increasing adult height, or mitigating psychosocial stresses and enhancing social adaptation.<ref name="mayo-treatment"/>

Forms of dwarfism associated with the endocrine system may be treated using [[hormonal therapy]]. If the cause is prepubescent hyposecretion of growth hormone, supplemental growth hormone may correct the abnormality. If the receptor for growth hormone is itself affected, the condition may prove harder to treat. [[Hypothyroidism]] is another possible cause of dwarfism that can be treated through hormonal therapy. Injections of thyroid hormone can mitigate the effects of the condition, but physical complications may be permanent.

Pain and disability may be ameliorated by physical therapy, braces or other orthotic devices, or by surgical procedures.<ref name='mayo-treatment'/> The only simple interventions that increase perceived adult height are dress enhancements, such as shoe lifts or hairstyle. Growth hormone is rarely used for shortness caused by bone dysplasias, since the height benefit is typically small (less than 5&nbsp;cm [2 in]) and the cost high.<ref name="pmid14671400"/> The most effective means of increasing adult height by several inches is [[distraction osteogenesis]], though availability is limited and the cost is high in terms of money, discomfort, and disruption of life. Most people with dwarfism do not choose this option, and it remains controversial.<ref name="LPA"/> For other types of dwarfism, surgical treatment is not possible.

==Society and culture==

===Terminology===
The appropriate term for describing a person of particularly short stature (or with the genetic condition achondroplasia) has historically been ambiguous, and has developed euphemistically over the past few centuries.

"[[Midget]]", whose etymology indicates a "small sandfly,"<ref name='midget-def'>{{cite web|url=http://dictionary.reference.com/browse/midget |title=midget |accessdate=2008-11-18 |work=Online Etymology Dictionary |publisher=Dictionary.com }}</ref> came into prominence in the mid-1800s after [[Harriet Beecher Stowe]] used it in her novels ''Sunny Memories of Foreign Lands'' and ''[[Old Town Folks]]'' where she described children and an extremely short man, respectively.<ref name="dwarfism-pbshome"/>  Later most people of short stature considered the word to be offensive because it was the descriptive term applied to [[P. T. Barnum]]'s dwarfs used for public amusement during the [[freak show]] era.<ref name="LPA"/> It is also not considered accurate as it is not a medical term or diagnosis, though it is sometimes used as a slang term to describe those who are particularly short, whether or not they have dwarfism.<ref name='midget-med'>{{cite web|url=http://www.medterms.com/script/main/art.asp?articlekey=22596 |title=Midget definition |accessdate=2008-11-18 |date=3/9/2003 |work=MedicineNet |publisher=MedicineNet, Inc.}}</ref>

The first notable use of the term "dwarf" was by the [[Brothers Grimm]] in their fairy tale ''[[Snow White]]'';<ref name='snow-white'>{{cite book | last = Grimm | first = Jacob and Wilhelm | authorlink = Brothers Grimm | title = Snow White | publisher = The Harvard Classics | date = | url = http://www.bartleby.com/17/2/25.html | isbn = }}</ref> [[Jonathan Swift]] also used it in ''[[Gulliver's Travels]]'' to describe a giant who was only 20&nbsp;ft tall compared to his 40&nbsp;ft peers.<ref name='gullivers-travels'>{{cite book | last = Swift | first = Jonathan | authorlink = Jonathan Swift | title = Gulliver's Travels | publisher = Harrap | year = 1919 | location = | pages = | url = http://books.google.com/?id=IE5bAAAAMAAJ | isbn = }}</ref> The word "dwarf" has also been condemned by some as not only inaccurate but also insensitive due to its mythical and fairy tale origins.<ref name="LPA"/>

The terms "dwarf", "little person", "LP", and "person of short stature" are now generally considered acceptable by most people affected by these disorders.<ref name='dwarfism-pbshome'/>

===Art and media depictions===

{{See also|List of Dwarfism media depictions|List of people with dwarfism}}
In art, literature, or movies, dwarfs are rarely depicted as "regular people who are very short" but rather as a species apart. [[Novelist]]s, [[artist]]s, and [[film-maker|moviemaker]]s may attach special moral or aesthetic significance to their "apartness" or misshapenness.

Artistic representations of dwarfism can be found on [[ancient Greece|Greek]] vases and other ancient artifacts, including [[ancient Egypt]]ian art in which dwarfs are likely to have been seen as a divine manifestation, with records indicating they could reach high positions in society.<ref name="nunn">"''Ancient Egyptian Medicine''",John F. Nunn, University of Oklahoma Press, 2002, p. 78-79, ISBN 0-8061-3504-2</ref><ref>[http://www.sciencedaily.com/releases/2005/12/051227102614.htm  ''Dwarfs Commanded Respect In Ancient Egypt'', ScienceDaily, 27 Dec 2005]</ref>

The [[Bhagavat Purana]] [[Hindu]] text devotes nine chapters to the adventures of [[Vamana]], a dwarf avatar of Vishnu.

Depiction of dwarfs is also found in European paintings and many illustrations. Many European paintings (especially [[Spain|Spanish]]) of the 16th&ndash;19th centuries depict dwarfs by themselves or with others. In the [[Talmud]], it is said that the second born son of the [[Egypt]]ian [[Pharaoh]] of the [[Bible]] was a dwarf.<ref>[http://www.sacred-texts.com/jud/pol/pol09.htm The Talmud - Chapter Vi. Death Of Jacob And His Sons--Moses--The Deliverance From Egypt.] URL accessed April 23, 2007.</ref> Recent scholarship has suggested that ancient Egyptians held dwarfs in high esteem.<ref name='dwarfism-egypt'>{{cite journal|title=Dwarfs in ancient Egypt|journal=American Journal of Medical Genetics|date=2005-12-27|first=Chahira|last=Kozma|coauthors=|volume=140A|issue=4|pages=303–311|doi= 10.1002/ajmg.a.31068|url=http://www3.interscience.wiley.com/journal/112222883/abstract|format=|accessdate=2008-11-12|pmid=16380966}}</ref> Several important mythological figures of the North American [[Wyandot]] nation are portrayed as dwarfs.<ref>Trigger, Bruce G., ''The Children of Aataentsic: A History of the Huron People to 1660'' McGill-Queen's University Press, 1987 ISBN 0-7735-0627-6, p. 529.</ref>

As popular media have become more widespread, the number of works depicting dwarfs has increased dramatically. Some feel that dwarf characters are often depicted based on the novelty factor of their stature rather than on other personal attributes. Dwarfism is depicted in many books, films, and TV series such as [[Austin Powers]], [[Gulliver's Travels]] by [[Jonathan Swift]]<ref>''Gulliver's Travels: Complete, Authoritative Text with Biographical and Historical Contexts'', Palgrave Macmillan 1995 (p. 21). The quote has been misattributed to Alexander Pope, who wrote to Swift in praise of the book just a day earlier.
</ref>, [[The Wonderful Wizard of Oz|The Wizard of Oz]], [[Willy Wonka and the Chocolate Factory]], [[Little People Big World]], [[The Little Couple]], [[Harry Potter]], [[Seinfeld]], [[In Bruges]], [[The Tin Drum]] by [[Günter Grass]], and the film [[The Station Agent]].

The [[Animal Planet]] TV series ''[[Pit Boss (TV series)|Pit Boss]]'' features dwarf actor "Shorty" Rossi and his talent agency, "Shortywood Productions", which Rossi uses to provide funding for his pit bull rescue operation, "Shorty's Rescue".  Rossi's three full-time employees, featured in the series, are all Little People and aspiring actors.

==See also==
*[[Gigantism]]
*[[Human height]]
*[[Ellis–van Creveld syndrome]]
*[[Laron syndrome]]
*[[Mulibrey nanism]]
*[[List of people with dwarfism]]
*[[List of shortest people]]
*''[[Our Little Life]]'' (reality television show)

==References==
{{Reflist|2}}

==External links==
* [http://www.lpaonline.org/ Little People of America]
* [http://www.restrictedgrowth.co.uk/ Restricted Growth Association UK]
* [http://www.littlepeoplethebook.com/ ''Little People: A Father Reflects on His Daughter's Dwarfism — and What It Means to Be Different''], by Dan Kennedy. Critically acclaimed book in a free online edition.
{{Wiktionary|dwarf}}
{{commonscat-inline}}

[[Category:Growth disorders]]
[[Category:Human height]]

[[ca:Nanisme]]⏎
[[da:Dværg (menneske)]]
[[de:Minderwuchs]]
[[es:Enanismo]]
[[eo:Naneco]]
[[fr:Nanisme]]
[[it:Nanismo]]
[[he:גמדות]]
[[ja:小人症]]
[[no:Dvergvekst]]
[[pl:Karłowatość]]
[[pt:Nanismo]]
[[ru:Карлик]]
[[fi:Lyhytkasvuisuus]]
[[sv:Dvärgväxteu:Hiposomatotropismo]]
[[fr:Nanisme]]
[[id:Dwarfisme]]
[[it:Nanismo]]
[[he:גמדות]]
[[lt:Nanizmas]]
[[mr:बुटकेपणा]]
[[nl:Dwerggroei]]
[[ja:小人症]]
[[no:Kortvoksthet]]
[[pl:Karłowatość]]
[[pt:Nanismo]]
[[ro:Nanism]]
[[ru:Карлик]]
[[simple:Dwarfism]]
[[sk:Nanizmus]]
[[fi:Lyhytkasvuisuus]]
[[sv:Dvärgväxt]]
[[te:మరుగుజ్జు]]
[[yi:קארליק]]
[[zh:侏儒症]]