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Dwarfism is a condition of people and animals marked by unusually small size or short stature. In humans, it is sometimes defined as an adult height of less than , regardless of sex; the average adult height among people with dwarfism is . ''Disproportionate dwarfism'' is characterized by either short limbs or a short torso. In cases of ''proportionate dwarfism'', both the limbs and torso are unusually small. Intelligence is usually normal, and most people with it have a nearly normal life expectancy. People with dwarfism can usually bear children, although there are additional risks to the mother and child depending upon the underlying condition. The most common and recognizable form of dwarfism in humans (comprising 70% of cases) is
achondroplasia Achondroplasia is a genetic disorder with an autosomal dominant pattern of inheritance whose primary feature is dwarfism. It is the most common cause of dwarfism and affects about 1 in 27,500 people. In those with the condition, the Rhizomeli ...
, a
genetic disorder A genetic disorder is a health problem caused by one or more abnormalities in the genome. It can be caused by a mutation in a single gene (monogenic) or multiple genes (polygenic) or by a chromosome abnormality. Although polygenic disorders ...
whereby the limbs are diminutive.
Growth hormone deficiency Growth hormone deficiency (GHD), or hyposomatotropism, is a medical condition resulting from not enough growth hormone (GH). Generally the most noticeable symptom is that an individual attains a short height. Newborns may also present low blood ...
is responsible for most other cases. There are many other less common causes. Treatment of the condition depends on the underlying cause. Those with genetic disorders such as
osteochondrodysplasia An osteochondrodysplasia,Etymology: . or skeletal dysplasia, is a disorder of the development of bone and cartilage. Osteochondrodysplasias are rare diseases. About 1 in 5,000 babies are born with some type of skeletal dysplasia. Nonetheless, if t ...
can sometimes be treated with surgery or physical therapy. Hormone disorders can also be treated with
growth hormone therapy Growth hormone therapy refers to the use of growth hormone (GH) as a prescription medication—it is one form of hormone therapy. Growth hormone is a peptide hormone secreted by the pituitary gland that stimulates Cell growth, growth and cell (b ...
before the child's
growth plate The epiphyseal plate, epiphysial plate, physis, or growth plate is a hyaline cartilage plate in the metaphysis at each end of a long bone. It is the part of a long bone where new bone growth takes place; that is, the whole bone is alive, with ma ...
s fuse. Individual accommodations such as specialized furniture, are often used by people with dwarfism. Many
support groups In a support group, members provide each other with various types of help, usually nonprofessional and nonmaterial, for a particular shared, usually burdensome, characteristic. Members with the same issues can come together for sharing coping str ...
provide services to aid individuals and the
discrimination Discrimination is the process of making unfair or prejudicial distinctions between people based on the groups, classes, or other categories to which they belong or are perceived to belong, such as race, gender, age, class, religion, or sex ...
they may face. In addition to the medical aspect of the condition there are social aspects. For a person with dwarfism, height discrimination can lead to ridicule in childhood and discrimination in adulthood. In the United Kingdom, United States,
Canada Canada is a country in North America. Its Provinces and territories of Canada, ten provinces and three territories extend from the Atlantic Ocean to the Pacific Ocean and northward into the Arctic Ocean, making it the world's List of coun ...
,
Australia Australia, officially the Commonwealth of Australia, is a country comprising mainland Australia, the mainland of the Australia (continent), Australian continent, the island of Tasmania and list of islands of Australia, numerous smaller isl ...
, and other English-speaking countries, labels that some people with dwarfism accept include ''dwarf'' (plural: ''dwarfs''), ''little person'' (LP), or ''person of short stature'' (see
terminology Terminology is a group of specialized words and respective meanings in a particular field, and also the study of such terms and their use; the latter meaning is also known as terminology science. A ''term'' is a word, Compound (linguistics), com ...
). Historically, the term ''
midget Midget (from ''midge'', a tiny biting insect) is a term for a person of unusually short stature that is considered by some to be pejorative due to its etymology. While not a Medical terminology, medical term like ''dwarf'' (for a person with d ...
'' was used to describe dwarfs (primarily proportionate); however, some now consider this term offensive.


Signs and symptoms

Dwarfism has been defined as having an adult height of less than , or alternatively, having a height of at least two
standard deviation In statistics, the standard deviation is a measure of the amount of variation of the values of a variable about its Expected value, mean. A low standard Deviation (statistics), deviation indicates that the values tend to be close to the mean ( ...
s less than the mean of an individual's population, considering age, sex, and ancestry. There is a wide range of physical characteristics. Variations in individuals are identified by diagnosing and monitoring the underlying disorders. There may not be any complications outside adapting to their size.
Short stature Short stature refers to a height of a human which is below typical. Whether a person is considered short depends on the context. Because of the lack of preciseness, there is often disagreement about the degree of shortness that should be called ...
is a common replacement of the term 'dwarfism', especially in a medical context. However, those with mild
skeletal dysplasias An osteochondrodysplasia,Etymology: . or skeletal dysplasia, is a disorder of the development of bone and cartilage. Osteochondrodysplasias are rare diseases. About 1 in 5,000 babies are born with some type of skeletal dysplasia. Nonetheless, if t ...
may not be affected by dwarfism. In some cases of untreated
hypochondroplasia Hypochondroplasia (HCH) is a developmental disorder caused by an autosomal dominant genetic defect in the fibroblast growth factor receptor 3 gene ('' FGFR3'') that results in a disproportionately short stature, micromeliaupdate 2013 and a head t ...
, males grow up to . Though that is short in a relative context, it does not fall into the extreme ranges of the growth charts. Disproportionate dwarfism is characterized by shortened limbs or a shortened torso. In
achondroplasia Achondroplasia is a genetic disorder with an autosomal dominant pattern of inheritance whose primary feature is dwarfism. It is the most common cause of dwarfism and affects about 1 in 27,500 people. In those with the condition, the Rhizomeli ...
one has an average-sized trunk with short limbs and a larger forehead. Facial features are often affected and individual body parts may have problems associated with them.
Spinal stenosis Spinal stenosis is an abnormal narrowing of the spinal canal or neural foramen that results in pressure on the spinal cord or nerve roots. Symptoms may include pain, numbness, or weakness in the arms or legs. Symptoms are typically gradual in ...
, ear infection, and
hydrocephalus Hydrocephalus is a condition in which cerebrospinal fluid (CSF) builds up within the brain, which can cause pressure to increase in the skull. Symptoms may vary according to age. Headaches and double vision are common. Elderly adults with n ...
are common. In case of spinal dysostosis, one has a small trunk, with average-sized limbs. Proportionate dwarfism is marked by a short torso with short limbs, thus leading to a height that is significantly below average. There may be long periods without any significant growth.
Sexual development Puberty is the process of physical changes through which a child's Human body, body matures into an adult body capable of sexual reproduction. It is initiated by hormone, hormonal signals from the Human brain, brain to the gonads: the ovary ...
is often delayed or impaired into adulthood. This dwarfism type is caused by an endocrine disorder and not a skeletal dysplasia. Physical effects of malformed bones vary according to the specific disease. Many involve joint pain caused by abnormal bone alignment, or from
nerve A nerve is an enclosed, cable-like bundle of nerve fibers (called axons). Nerves have historically been considered the basic units of the peripheral nervous system. A nerve provides a common pathway for the Electrochemistry, electrochemical nerv ...
compression. Early degenerative joint disease, exaggerated
lordosis Lordosis is historically defined as an ''abnormal'' inward curvature of the lumbar spine. However, the terms ''lordosis'' and ''lordotic'' are also used to refer to the normal inward curvature of the lumbar and cervical vertebrae, cervical regio ...
or
scoliosis Scoliosis (: scolioses) is a condition in which a person's Vertebral column, spine has an irregular curve in the coronal plane. The curve is usually S- or C-shaped over three dimensions. In some, the degree of curve is stable, while in others ...
, and constriction of
spinal cord The spinal cord is a long, thin, tubular structure made up of nervous tissue that extends from the medulla oblongata in the lower brainstem to the lumbar region of the vertebral column (backbone) of vertebrate animals. The center of the spinal c ...
or nerve roots can cause pain and disability. Reduced
thoracic The thorax (: thoraces or thoraxes) or chest is a part of the anatomy of mammals and other tetrapod animals located between the neck and the abdomen. In insects, crustaceans, and the extinct trilobites, the thorax is one of the three main ...
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 The brain is an organ (biology), organ that serves as the center of the nervous system in all vertebrate and most invertebrate animals. It consists of nervous tissue and is typically located in the head (cephalization), usually near organs for ...
or
liver The liver is a major metabolic organ (anatomy), organ exclusively found in vertebrates, which performs many essential biological Function (biology), functions such as detoxification of the organism, and the Protein biosynthesis, synthesis of var ...
, sometimes severely enough to be more of an impairment than the unusual bone growth. Mental effects also vary according to the specific underlying syndrome. In most cases of skeletal dysplasia, such as achondroplasia, mental function is not impaired. 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. The psycho-social limitations of society may be more disabling 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. * Numerous studies have demonstrated reduced employment opportunities. Severe shortness is associated with lower income. *
Self-esteem Self-esteem is confidence in one's own worth, abilities, or morals. Self-esteem encompasses beliefs about oneself (for example, "I am loved", "I am worthy") as well as emotional states, such as triumph, despair, pride, and shame. Smith and Macki ...
may decline and family relationships may be affected. * Extreme shortness (in the range) can, if not accommodated for, interfere with
activities of daily living Activities of daily living (ADLs) is a term used in healthcare to refer to an individual's daily self-care activities. Health professionals often use a person's ability or inability to perform ADLs as a measure of their Performance status, functi ...
, like driving or using countertops built for taller people. Other common attributes of dwarfism such as bowed knees and unusually short fingers can lead to back problems and 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.


Causes

Dwarfism can result from many medical conditions, each with its own separate symptoms and causes. Extreme shortness in humans with proportional body parts usually has a hormonal cause, such as
growth hormone deficiency Growth hormone deficiency (GHD), or hyposomatotropism, is a medical condition resulting from not enough growth hormone (GH). Generally the most noticeable symptom is that an individual attains a short height. Newborns may also present low blood ...
, once called ''pituitary dwarfism''. Achondroplasia is responsible for the majority of human dwarfism cases, followed by spondyloepiphyseal dysplasia and diastrophic dysplasia.


Achondroplasia

The most recognizable and most common form of dwarfism in humans is achondroplasia, which accounts for 70% of dwarfism cases, and occurs in 4 to 15 out of 100,000 live births. It produces rhizomelic short limbs, increased spinal curvature, and distortion of skull growth. In achondroplasia the body's limbs are proportionately shorter than the trunk (abdominal area), with a larger head than average and characteristic facial features. Achondroplasia is an
autosomal dominant In genetics, dominance is the phenomenon of one variant (allele) of a gene on a chromosome masking or overriding the Phenotype, effect of a different variant of the same gene on Homologous chromosome, the other copy of the chromosome. The firs ...
disorder caused by the presence of an altered
allele An allele is a variant of the sequence of nucleotides at a particular location, or Locus (genetics), locus, on a DNA molecule. Alleles can differ at a single position through Single-nucleotide polymorphism, single nucleotide polymorphisms (SNP), ...
in the genome. If a pair of achondroplasia alleles are present, the result is fatal, usually perinatally. Achondroplasia is a mutation in the fibroblast growth factor receptor 3. In the context of achondroplasia, this mutation causes FGFR3 to become constitutively active, inhibiting bone growth.


Growth hormone deficiency

Growth hormone deficiency (GHD) is a medical condition in which the body produces insufficient
growth hormone Growth hormone (GH) or somatotropin, also known as human growth hormone (hGH or HGH) in its human form, is a peptide hormone that stimulates growth, cell reproduction, and cell regeneration in humans and other animals. It is thus important in ...
. Growth hormone, also called somatotropin, is a
polypeptide Peptides are short chains of amino acids linked by peptide bonds. A polypeptide is a longer, continuous, unbranched peptide chain. Polypeptides that have a molecular mass of 10,000 Da or more are called proteins. Chains of fewer than twenty ...
hormone A hormone (from the Ancient Greek, Greek participle , "setting in motion") is a class of cell signaling, signaling molecules in multicellular organisms that are sent to distant organs or tissues by complex biological processes to regulate physio ...
which stimulates 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 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, or even stress (leading to
psychogenic dwarfism Psychosocial short stature (PSS) is a Growth disorders, growth disorder that is observed between the ages of 2 and 15, caused by extreme emotional deprivation or stress (medicine), stress. The symptoms include decreased growth hormone (GH) and so ...
). Laron syndrome (growth hormone insensitivity) is another cause. Those with growth hormone issues tend to be proportionate.


Metatropic dysplasia

Metatropic means "changing form" and refers to this form of skeletal dysplasia as there is an abnormality in the growth plates. Skeletal changes continue over time and may need surgical intervention to help protect the lungs. Symptoms starting at birth may be mild or can be fatal. There are recognizable features in individuals with this genetic disorder. Some are short stature, narrow chest, "facial features such as a prominent forehead, underdevelopment of the upper jaw, cheekbones and eye sockets (midface hypoplasia), and a squared-off jaw." It is considered a more severe skeletal dysplasia, but is very rare, with the exact number of those affected unknown. Prognosis is largely on a case-by-case basis depending on the severity, and life expectancy may not be impacted unless there are respiratory complications.


Other

Other causes of dwarfism are spondyloepiphyseal dysplasia congenita, diastrophic dysplasia, pseudoachondroplasia,
hypochondroplasia Hypochondroplasia (HCH) is a developmental disorder caused by an autosomal dominant genetic defect in the fibroblast growth factor receptor 3 gene ('' FGFR3'') that results in a disproportionately short stature, micromeliaupdate 2013 and a head t ...
, Noonan syndrome,
primordial dwarfism Primordial dwarfism (PD) is a form of dwarfism that results in a smaller body size in all stages of life beginning from before birth. More specifically, primordial dwarfism is a diagnostic category including specific types of profoundly proportion ...
,
Cockayne syndrome Cockayne syndrome (CS), also called Neill-Dingwall syndrome, is a rare and fatal autosomal recessive neurodegenerative disorder characterized by growth failure, impaired development of the nervous system, abnormal sensitivity to sunlight ( photo ...
,
Kniest dysplasia Kniest dysplasia is a rare form of dwarfism caused by a mutation in the '' COL2A1'' gene on chromosome 12. The ''COL2A1'' gene is responsible for producing type II collagen. The mutation of the ''COL2A1'' gene leads to abnormal skeletal growth an ...
,
Turner syndrome Turner syndrome (TS), commonly known as 45,X, or 45,X0,Also written as 45,XO. is a chromosomal disorder in which cells of females have only one X chromosome instead of two, or are partially missing an X chromosome (sex chromosome monosomy) lea ...
,
osteogenesis imperfecta Osteogenesis imperfecta (; OI), colloquially known as brittle bone disease, is a group of genetic disorders that all result in bones that bone fracture, break easily. The range of symptoms—on the skeleton as well as on the body's other Or ...
(OI), and
hypothyroidism Hypothyroidism is an endocrine disease in which the thyroid gland does not produce enough thyroid hormones. It can cause a number of symptoms, such as cold intolerance, poor ability to tolerate cold, fatigue, extreme fatigue, muscle aches, co ...
. Severe shortness with skeletal distortion also occurs in several of the mucopolysaccharidoses and other storage disorders. Hypogonadotropic hypogonadism may cause proportionate, yet temporary, dwarfism. NPR2 disproportionate dwarfism was discovered recently and is caused by a mutant gene.


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 Genetic testing, also known as DNA testing, is used to identify changes in DNA sequence or chromosome structure. Genetic testing can also include measuring the results of genetic changes, such as RNA analysis as an output of gene expression, or ...
and diagnostic imaging may be used to determine the exact condition. 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. Short stature or stunted growth during youth is usually what brings the condition to medical attention. Skeletal
dysplasia Dysplasia is any of various types of abnormal growth or development of cells (microscopic scale) or organs (macroscopic scale), and the abnormal histology or anatomical structure(s) resulting from such growth. Dysplasias on a mainly microscopic ...
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 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 Genetic counseling is the process of investigating individuals and families affected by or at risk of genetic disorders to help them understand and adapt to the medical, psychological and familial implications of genetic contributions to disease. ...
. Since about the year 2000, genetic tests for some of the specific disorders have become available. During an initial medical evaluation of shortness, the absence of disproportion and other clues listed above usually indicates causes other than bone dysplasias.


Classification

In men and women, the sole requirement for being considered a dwarf is having an adult height under and it is almost always sub-classified with respect to the underlying condition that is the cause of the short stature. Dwarfism is usually caused by a genetic variant; achondroplasia is caused by a mutation on chromosome 4. 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 unusual 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 ** rhizomelic = root, i.e., bones of the upper arm or thigh ** mesomelic = middle, i.e., bones of the forearm or lower leg ** acromelic = end, i.e., 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 and chondrodystrophy.


Prevention

Many types of dwarfism are currently impossible to prevent because they are genetically caused. Genetic conditions that cause dwarfism may be identified with
genetic testing Genetic testing, also known as DNA testing, is used to identify changes in DNA sequence or chromosome structure. Genetic testing can also include measuring the results of genetic changes, such as RNA analysis as an output of gene expression, or ...
, by screening for the specific variations 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 human growth hormone (HGH) during early life.


Management

Genetic mutations of most forms of dwarfism caused by bone dysplasia cannot be altered yet, 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. 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 Hypothyroidism is an endocrine disease in which the thyroid gland does not produce enough thyroid hormones. It can cause a number of symptoms, such as cold intolerance, poor ability to tolerate cold, fatigue, extreme fatigue, muscle aches, co ...
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 lack of proportion may be permanent. Pain and disability may be ameliorated by physical therapy, 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 caused by bone dysplasias, since the height benefit is typically small (less than ) and the cost high. The most effective means of increasing adult height by several inches is
distraction osteogenesis Distraction osteogenesis (DO), also called callus distraction, callotasis and osteodistraction, is a process used in orthopedic surgery, podiatric surgery, and oral and maxillofacial surgery to repair skeletal deformities and in reconstructive su ...
, 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. 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 Achondroplasia is a genetic disorder with an autosomal dominant pattern of inheritance whose primary feature is dwarfism. It is the most common cause of dwarfism and affects about 1 in 27,500 people. In those with the condition, the Rhizomeli ...
) has developed euphemistically. The noun ''dwarf'' stems from , originally referring to a being from
Germanic mythology Germanic mythology consists of the body of myths native to the Germanic peoples, including Norse mythology, Anglo-Saxon paganism#Mythology, Anglo-Saxon mythology, and Continental Germanic mythology. It was a key element of Germanic paganism. O ...
—a
dwarf Dwarf, dwarfs or dwarves may refer to: Common uses *Dwarf (folklore), a supernatural being from Germanic folklore * Dwarf, a human or animal with dwarfism Arts, entertainment, and media Fictional entities * Dwarf (''Dungeons & Dragons''), a sh ...
—that dwells in mountains and in the earth, and is associated with wisdom, smithing, mining, and crafting. The
etymology Etymology ( ) is the study of the origin and evolution of words—including their constituent units of sound and meaning—across time. In the 21st century a subfield within linguistics, etymology has become a more rigorously scientific study. ...
of the word ''dwarf'' is contested, and scholars have proposed varying theories about the origins of the being, including that dwarfs may have originated as nature spirits or as beings associated with death, or as a mixture of concepts. Competing etymologies include a basis in the
Indo-European The Indo-European languages are a language family native to the northern Indian subcontinent, most of Europe, and the Iranian plateau with additional native branches found in regions such as Sri Lanka, the Maldives, parts of Central Asia (e. ...
root (meaning ), the Indo-European root (whence modern Dutch and ), and comparisons have been made with the Old Indian ''dhvaras'' (a type of demonic being). The being may not have gained associations with small stature until a later period. Simek, Rudolf (2007) translated by Angela Hall.
Dictionary of Northern Mythology
', pp. 67–68. D.S. Brewer
The terms "little person", "LP" and "person of short stature" are the preferred terms of many of those with this disorder, and while some are uncomfortable with "dwarf" it remains a common term in some areas. However, the plural "dwarfs" as opposed to "dwarves" is generally preferred in the medical context, possibly because the plural "dwarves" was popularized by author
J. R. R. Tolkien John Ronald Reuel Tolkien (, 3 January 1892 – 2 September 1973) was an English writer and philologist. He was the author of the high fantasy works ''The Hobbit'' and ''The Lord of the Rings''. From 1925 to 1945, Tolkien was the Rawlinson ...
, describing a race of characters in his ''
The Lord of the Rings ''The Lord of the Rings'' is an Epic (genre), epic high fantasy novel written by English author and scholar J. R. R. Tolkien. Set in Middle-earth, the story began as a sequel to Tolkien's 1937 children's book ''The Hobbit'' but eventually d ...
'' books resembling Norse dwarfs. "
Midget Midget (from ''midge'', a tiny biting insect) is a term for a person of unusually short stature that is considered by some to be pejorative due to its etymology. While not a Medical terminology, medical term like ''dwarf'' (for a person with d ...
", whose etymology indicates a "tiny biting insect", came into prominence in the mid-19th century after
Harriet Beecher Stowe Harriet Elisabeth Beecher Stowe (; June 14, 1811 – July 1, 1896) was an American author and Abolitionism in the United States, abolitionist. She came from the religious Beecher family and wrote the popular novel ''Uncle Tom's Cabin'' (185 ...
used it in her novels ''Sunny Memories of Foreign Lands'' and '' Oldtown Folks'' where she described children and an extremely short man, respectively. Later some people of short stature considered the word to be offensive because it was the descriptive term applied to
P. T. Barnum Phineas Taylor Barnum (July 5, 1810 – April 7, 1891) was an American showman, businessman, and politician remembered for promoting celebrated hoaxes and founding with James Anthony Bailey the Ringling Bros. and Barnum & Bailey Circus. He was ...
's dwarfs used for public amusement during the
freak show A freak show is an exhibition of biological rarities, referred to in popular culture as "Freak, freaks of nature". Typical features would be physically unusual Human#Anatomy and physiology, humans, such as those uncommonly large or small, t ...
era. 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.


Participation

Individuals with dwarfism are capable of actively participating in various aspects of society. They have access to education and sports, and can pursue careers, engaging in a wide range of professions.


Acceptance

Individuals with dwarfism often face prejudice and stereotypes. Research by Klein (2019) has demonstrated that awareness of the stigmatization of this group can promote full participation in society. The research by Green and Pinter (2018) in the field of humor and social psychology can provide insights to reduce stereotypes and promote a more objective perception.


Accommodation

In daily life, little people face numerous obstacles because the environment is tailored to average-sized individuals. Some little people can only use ATMs, kitchens, toilets, and sinks with aids. Low stools and step stools play a special role, as they can be used in various ways to bridge the height difference. Stools are also useful as footrests while sitting, as the legs of short people dangle in the air when sitting on an average chair, which can be painful and uncomfortable in the long run and may hinder fine motor skills during work. To be mobile, some individuals use customized scooters or bicycles, as it can be problematic, depending on the type of short stature, to walk longer distances. With specially adapted vehicles, most individuals of short stature can drive without further hindrances. Generally, pedal extensions and an individually adjusted seat at the correct height are required. Some little people are tall enough to drive without pedal extensions. Usually, patients with skeletal dysplasia with limited mobility can receive allowances or grants for vehicle assistance through governmental help or rehabilitation providers.


Dwarf sports

Dwarfs have support and compete in sport by a number of
organizations An organization or organisation ( Commonwealth English; see spelling differences) is an entity—such as a company, or corporation or an institution (formal organization), or an association—comprising one or more people and having a par ...
nationally and internationally. They are included in some events in the
athletics at the Summer Paralympics Athletics has been contested at every Summer Paralympics since the first games in 1960. Men and women from all disability groups compete in the sport. Some athletes use wheelchairs or prosthetic limbs and compete in their respective sport in ...
. The Dwarf Athletic Association of America and the Dwarf Sports Association UK provide opportunities for dwarfs to compete nationally and internationally in the Americas and Europe, respectively. The World Dwarf Games (WDG) are a multi-sport event for athletes of short stature. The WDG have been held every four years since 1993 and are the world's largest sporting event exclusively for athletes with dwarfism. The Dwarf Sports Association UK organizes between 5 and 20 events per month for athletes with restricted growth conditions in the UK. For instance, swimming and bicycling are often recommended for people with skeletal dysplasias, since those activities put minimal pressure on the spine. Since its early days,
professional wrestling Professional wrestling, often shortened to either pro wrestling or wrestling,The term "wrestling" is most often widely used to specifically refer to modern scripted professional wrestling, though it is also used to refer to Real life, real- ...
has had the involvement of dwarf athletes. " Midget wrestling" had its heyday in the 1950s–'70s, when wrestlers such as Little Beaver, Lord Littlebrook, and Fuzzy Cupid toured North America, and Sky Low Low was the first holder of the
National Wrestling Alliance The National Wrestling Alliance (NWA) is an American professional wrestling professional wrestling promotion, promotion and governing body owned by Billy Corgan and operated by its parent company Lightning One, Inc. Founded in 1948, the NWA be ...
's World Midget Championship. In the next couple of decades, more wrestlers became prominent in North America including foreign wrestlers like
Japan Japan is an island country in East Asia. Located in the Pacific Ocean off the northeast coast of the Asia, Asian mainland, it is bordered on the west by the Sea of Japan and extends from the Sea of Okhotsk in the north to the East China Sea ...
's Little Tokyo. Although the term is seen by some as pejorative, many past and current midget wrestlers including Hornswoggle said they take pride in the term due to its history in the industry and its marketability.


Art and media depictions

In art, literature, and movies, dwarfs are rarely depicted as ordinary people who are very short but rather as a species apart.
Novelist A novelist is an author or writer of novels, though often novelists also write in other genres of both fiction and non-fiction. Some novelists are professional novelists, thus make a living wage, living writing novels and other fiction, while other ...
s,
artist An artist is a person engaged in an activity related to creating art, practicing the arts, or demonstrating the work of art. The most common usage (in both everyday speech and academic discourse) refers to a practitioner in the visual arts o ...
s, and moviemakers may attach special moral or aesthetic significance to their "apartness" or misshapenness. Artistic representations of dwarfism are found on
Greek Greek may refer to: Anything of, from, or related to Greece, a country in Southern Europe: *Greeks, an ethnic group *Greek language, a branch of the Indo-European language family **Proto-Greek language, the assumed last common ancestor of all kno ...
vases and other ancient artifacts, including
ancient Egypt Ancient Egypt () was a cradle of civilization concentrated along the lower reaches of the Nile River in Northeast Africa. It emerged from prehistoric Egypt around 3150BC (according to conventional Egyptian chronology), when Upper and Lower E ...
ian art in which dwarfs are likely to have been seen as a divine manifestation, with records indicating that they were able to reach high positions in society at the time.''Ancient Egyptian Medicine'', John F. Nunn, University of Oklahoma Press, 2002, pp. 78–79, The ancient
Hindu Hindus (; ; also known as Sanātanīs) are people who religiously adhere to Hinduism, also known by its endonym Sanātana Dharma. Jeffery D. Long (2007), A Vision for Hinduism, IB Tauris, , pp. 35–37 Historically, the term has also be ...
text '' Bhagavat Purana'' devotes nine chapters to the adventures of
Vamana Vamana (, ) also known as Trivikrama (), Urukrama (), Upendra (), Dadhivamana (, ), and Balibandhana (), is an Dashavatara, avatar of the Hinduism, Hindu deity Vishnu. He is the fifth avatar of Vishnu and the first Dashavatara in the Treta ...
, a dwarf avatar of Lord Vishnu. Depictions of dwarfism are also found in European paintings and many illustrations. Many European paintings (especially Spanish) of the 16th–19th centuries depict dwarfs by themselves or with others. In the
Talmud The Talmud (; ) is the central text of Rabbinic Judaism and the primary source of Jewish religious law (''halakha'') and Jewish theology. Until the advent of Haskalah#Effects, modernity, in nearly all Jewish communities, the Talmud was the cen ...
, it is said that the second born son of the
Egypt Egypt ( , ), officially the Arab Republic of Egypt, is a country spanning the Northeast Africa, northeast corner of Africa and Western Asia, southwest corner of Asia via the Sinai Peninsula. It is bordered by the Mediterranean Sea to northe ...
ian
Pharaoh Pharaoh (, ; Egyptian language, Egyptian: ''wikt:pr ꜥꜣ, pr ꜥꜣ''; Meroitic language, Meroitic: 𐦲𐦤𐦧, ; Biblical Hebrew: ''Parʿō'') was the title of the monarch of ancient Egypt from the First Dynasty of Egypt, First Dynasty ( ...
of the
Bible The Bible is a collection of religious texts that are central to Christianity and Judaism, and esteemed in other Abrahamic religions such as Islam. The Bible is an anthology (a compilation of texts of a variety of forms) originally writt ...
was a dwarf. Recent scholarship has suggested that ancient Egyptians held dwarfs in high esteem. Several important mythological figures of the North American Wyandot nation are portrayed as dwarfs. As popular media has become more widespread, the number of works depicting dwarfs have increased dramatically. Dwarfism is depicted in many books, films, and TV series such as ''
Willow Willows, also called sallows and osiers, of the genus ''Salix'', comprise around 350 species (plus numerous hybrids) of typically deciduous trees and shrubs, found primarily on moist soils in cold and temperate regions. Most species are known ...
'', ''
The Wild Wild West ''The Wild Wild West'' is an American Western (genre), Western, spy film, spy, and science fiction on television, science fiction television series that ran on the CBS television network for four seasons from September 17, 1965, to April 11, 19 ...
'', '' The Man with the Golden Gun'' (and later parodied in''
Austin Powers ''Austin Powers'' is a series of American satirical spy comedy films created by Mike Myers, who stars as the British spy Austin Powers as well as his arch-nemesis, Dr. Evil. The series consists of '' International Man of Mystery'' (1997), ' ...
''), ''
Gulliver's Travels ''Gulliver's Travels'', originally titled ''Travels into Several Remote Nations of the World. In Four Parts. By Lemuel Gulliver, First a Surgeon, and then a Captain of Several Ships'', is a 1726 prose satire by the Anglo-Irish writer and clerg ...
'' by
Jonathan Swift Jonathan Swift (30 November 1667 – 19 October 1745) was an Anglo-Irish writer, essayist, satirist, and Anglican cleric. In 1713, he became the Dean (Christianity), dean of St Patrick's Cathedral, Dublin, and was given the sobriquet "Dean Swi ...
,''Gulliver's Travels: Complete, Authoritative Text with Biographical and Historical Contexts'', Palgrave Macmillan 1995 (p. 21). The quote has been misattributed to
Alexander Pope Alexander Pope (21 May 1688 Old Style and New Style dates, O.S. – 30 May 1744) was an English poet, translator, and satirist of the Age of Enlightenment, Enlightenment era who is considered one of the most prominent English poets of the early ...
, who wrote to Swift in praise of the book just a day earlier.
'' The Wizard of Oz'', ''
Willy Wonka & the Chocolate Factory ''Willy Wonka & the Chocolate Factory'' is a 1971 American musical film, musical fantasy film directed by Mel Stuart from a screenplay by Roald Dahl, based on his 1964 novel ''Charlie and the Chocolate Factory''. It stars Gene Wilder as chocol ...
'', ''
Bad Santa ''Bad Santa'' is a 2003 American Christmas black comedy crime film directed by Terry Zwigoff, written by Glenn Ficarra and John Requa, and starring Billy Bob Thornton in the title role, with a supporting cast of Tony Cox, Lauren Graham, Bre ...
'', '' A Son of the Circus'', '' Little People, Big World'', '' The Little Couple'', ''
A Song of Ice and Fire ''A Song of Ice and Fire'' is a series of high fantasy novels by the American author George R. R. Martin. Martin began writing the first volume, ''A Game of Thrones'', in 1991, and published it in 1996. Martin, who originally envisioned the ser ...
'' (and its TV adaptation ''
Game of Thrones ''Game of Thrones'' is an American Fantasy television, fantasy Drama (film and television), drama television series created by David Benioff and for HBO. It is an adaptation of ''A Song of Ice and Fire'', a series of high fantasy novels by ...
''), ''
Seinfeld ''Seinfeld'' ( ) is an American television sitcom created by Larry David and Jerry Seinfeld that originally aired on NBC from July 5, 1989, to May 14, 1998, with a total of nine seasons consisting of List of Seinfeld episodes, 180 episodes. It ...
'', '' The Orator'', '' In Bruges'', ''
The Tin Drum ''The Tin Drum'' (, ) is a 1959 novel by Günter Grass, the first book of his Danzig Trilogy. It was adapted into a 1979 film, which won both the 1979 Palme d'Or and the Academy Award for Best Foreign Language Film in 1980. To "beat a ti ...
'' by
Günter Grass Günter Wilhelm Grass (; 16 October 1927 – 13 April 2015) was a German novelist, poet, playwright, illustrator, graphic artist, sculptor, and recipient of the 1999 Nobel Prize in Literature. He was born in the Free City of Danzig (now Gda ...
, the short-lived reality show '' The Littlest Groom'', and the films '' The Station Agent'' and ''
Zero 0 (zero) is a number representing an empty quantity. Adding (or subtracting) 0 to any number leaves that number unchanged; in mathematical terminology, 0 is the additive identity of the integers, rational numbers, real numbers, and compl ...
''. The
Animal Planet Animal Planet (stylized in all lowercase since 2018) is an American multinational pay television channel focusing on the animal kingdom owned by the Warner Bros. Discovery Networks unit of Warner Bros. Discovery. First established on June 1 ...
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 little people and aspiring actors. In September 2014, Creative Business House along with Donnons Leur Une Chance, created the International Dwarf Fashion Show to raise awareness and boost self-confidence of people living with dwarfism. A number of reality television series on Lifetime, beginning with '' Little Women: LA'' in 2014, focused on showing the lives of women living with dwarfism in various cities around the United States.


See also

* Dwarfs and pygmies in Ancient Egypt * Dwarfism Awareness Month * Dwarf-tossing * Ellis–Van Creveld syndrome *
Gigantism Gigantism (, ''gígas'', "wiktionary:giant, giant", plural γίγαντες, ''gígantes''), also known as giantism, is a condition characterized by excessive growth and height significantly above average height, average. In humans, this conditi ...
*
Human height Human height or stature is the distance from the bottom of the feet to the top of the head in a human body, standing erect. It is measured using a stadiometer, in centimetres when using the metric system or SI system, or feet and inches when ...
* Island dwarfism * Itabaianinha, a city in Brazil historically noted for its dwarf population * Kingdom of the Little People * Laron syndrome * List of people with dwarfism * List of dwarfism organisations * List of the verified shortest people *
Midget Midget (from ''midge'', a tiny biting insect) is a term for a person of unusually short stature that is considered by some to be pejorative due to its etymology. While not a Medical terminology, medical term like ''dwarf'' (for a person with d ...
* Mulibrey nanism *
Phyletic dwarfism Phyletic dwarfism is the decrease in average size of animals of a species. There are a few circumstances that often lead to species doing this. Lack of predators of smaller creatures can allow smaller members of a species to survive. The lack of ...
*
Short stature Short stature refers to a height of a human which is below typical. Whether a person is considered short depends on the context. Because of the lack of preciseness, there is often disagreement about the degree of shortness that should be called ...
*
Pygmy peoples In anthropology, pygmy peoples are ethnic groups whose average height is unusually short. The term pygmyism is used to describe the phenotype of endemic short stature (as opposed to disproportionate dwarfism occurring in isolated cases in a po ...
* Dwarf hamster (disambiguation) * Dwarf rabbit


References


External links


Little People of the World Organization
ub for all International Organizations; services/advocacy/know your rights/support
Little People of America
(Includes a list of International support groups)
Little People of Canada
(Includes a list of Canadian Provincial support groups)
Little People UK

Dwarf Sports Association UK

Restricted Growth Association UK
{{Authority control Growth disorders Human height