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More than 200 conditions are known to cause extreme short stature (dwarfism). While a good number of people with dwarfism are diagnosed with a specific type, some conditions go undiagnosed and may be the only type in the world. Most are caused by a spontaneous genetic alteration or changes in the egg or sperm cells prior to conception. Other conditions are caused by genes inherited from one or both parents. In either of these cases, two average-size parents can have a child with dwarfism (though this is far more likely to occur with a spontaneous alteration). Similarly, depending on the type of condition causing the extreme short stature, it is possible for Little People to have an average-size child (see Cara's Story).

What prompts a gene to change is not yet clearly understood. The change is seemingly random and unpreventable, and can occur in any pregnancy. Generally, when average-size parents have a child with dwarfism due to a spontaneous mutation, it is rare to have a second child who is also of extreme short stature. However, if parents have dwarfism themselves, the odds are much greater that their children will have it as well.

Dwarfism has other causes, including metabolic or hormonal disorders in infancy or childhood. Chromosomal abnormalities, pituitary gland disorders (which influence growth and metabolism), absorptive problems (when the body can't absorb nutrients adequately), and kidney disease can all lead to short stature if a child fails to grow at an average rate.

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