Key takeaways
- Delayed growth means a child is growing more slowly than expected for their age. It’s often due to constitutional delay or familial short stature. Other potential causes include growth hormone (GH) deficiency, hypothyroidism, and Turner syndrome (TS).
- Diagnosis involves tracking growth over time, X-rays to check bone development, and sometimes blood tests to identify hormone imbalances or underlying conditions.
- Treatment may include daily GH injections for GH deficiency, thyroid hormone replacement for hypothyroidism, or no intervention if the delay is due to familial short stature. Early treatment can help a child reach typical or near-typical adult height.
A healthcare professional may diagnose a growth delay if a child is short for their age or is not growing at a typical rate. The delay may occur due to an underlying health condition, such as growth hormone deficiency or hypothyroidism, or it may result from having a parent with short height.
In some cases, early treatment can help a child reach a typical or near-typical height, though many cases do not result from a treatable medical growth problem.
If you suspect your child isn’t growing at an expected rate, make an appointment with their doctor, as it may be a sign of other health issues.
If your child is smaller than other children their age, they may have a growth problem. Boston Children’s Hospital considers a child short if they are smaller than 95% of children their age and have a slow rate of growth.
Healthcare professionals may diagnose a growth delay in a child whose height is within the expected range but whose growth rate has slowed.
Depending on the underlying cause of their growth delay, they may have other symptoms:
- If they have certain forms of dwarfism, the length of their arms or legs may be out of proportion to their torso.
- If they have low levels of the hormone thyroxine, they may experience fatigue, constipation, dry skin, dry hair, and difficulty staying warm.
- If they have low growth hormone (GH) levels, it may affect facial growth, making them look unusually young.
- If their delayed growth occurs due to stomach or bowel disease, they may have blood in their stool, diarrhea, constipation, vomiting, or nausea.
Delayed growth can have many causes. The most common causes include:
A family history of short stature
If parents or other family members have short stature, it’s common for a child to grow more slowly than their peers.
Delayed growth due to family history isn’t an indication of an underlying problem. The child may be shorter than average simply because of genetics.
Constitutional growth delay
Children with this condition are shorter than average but grow at a typical rate. They usually have a delayed “bone age,” meaning their bones mature more slowly than their chronological age.
They also tend to reach puberty later than their peers. This leads to a below-average height in early teenage years, but they tend to catch up with their peers in adulthood.
Growth hormone deficiency
Under normal circumstances, GH promotes the growth of body tissues. Children with a partial or complete GH deficiency won’t be able to sustain a healthy rate of growth.
Hypothyroidism
Babies or children with hypothyroidism have an underactive thyroid gland.
The thyroid gland is responsible for releasing hormones that promote growth, so delayed growth is a possible sign of an underactive thyroid.
Turner syndrome
Turner syndrome (TS) is a genetic condition that affects females who are missing a part or all of one X chromosome. TS affects approximately
While children with TS produce normal amounts of GH, their bodies don’t use it effectively.
Other causes of delayed growth
Other causes of slow growth include:
- Down syndrome, a genetic condition in which individuals have 47 chromosomes instead of the usual 46
- skeletal dysplasia, a group of conditions that cause problems with bone growth
- certain types of anemia, such as sickle cell anemia
- kidney, heart, digestive, or lung diseases
- use of certain drugs by the birth mother during pregnancy
- malnutrition
- severe stress
Your child’s doctor will start by taking a detailed medical history. They’ll collect information about your child’s personal and family health history, including:
- the birth mother’s pregnancy
- the child’s length and weight at birth
- the heights of other people in their family
- information about other family members who have experienced growth delays
The doctor may also chart your child’s growth for 6 months or more.
Certain tests and imaging studies can also help the doctor develop a diagnosis. A hand and wrist X-ray can provide important information about your child’s bone development in relation to their age. Blood tests can identify problems with hormone imbalances or help detect certain diseases of the stomach, bowel, kidney, or bones.
In some cases, the doctor may ask your child to stay overnight in the hospital for blood testing. This is because much of GH production happens while your child sleeps.
Also, delayed growth and short stature may sometimes be an expected part of a syndrome that your child has already been diagnosed with, such as Down syndrome or Turner syndrome.
Your child’s treatment plan will depend on the cause of their delayed growth.
For delayed growth associated with a family history or constitutional delay, doctors don’t usually recommend any treatments or interventions.
For other underlying causes, the following treatments or interventions may help them start growing at an expected rate.
Growth hormone deficiency
If your child is diagnosed with a GH deficiency, their doctor may recommend GH replacement therapy. This involves giving GH injections once per day, and it can usually be done at home by a parent.
This treatment will likely continue for several years as your child continues growing. Your child’s doctor will monitor the effectiveness of the GH treatment and adjust the dosage accordingly.
Hypothyroidism
Your child’s doctor may prescribe thyroid hormone replacement drugs to compensate for your child’s underactive thyroid gland. During treatment, the doctor will watch your child’s thyroid hormone levels regularly.
Some children naturally outgrow the disorder within a few years, but others may need to continue treatment for the rest of their lives.
Turner syndrome
Even though children with TS produce GH naturally, their bodies can use it more effectively when it’s administered through injections. When your child is around age
Similar to the treatment for GH deficiency, you can usually give the injections to your child at home. If the injections aren’t managing your child’s symptoms, the doctor can adjust the dosage.
There are more possible underlying causes than the ones listed above. Depending on the cause, there may be other available treatments for your child’s delayed growth. For more information, talk with your child’s doctor about how you can help your child reach an average adult height.
Your child’s outlook will depend on the cause of their growth delay and when they begin treatment. If their condition is diagnosed and treated early, they may reach expected or near-expected height.
Waiting too long to start treatment can raise their risk of short stature and other complications. Once the growth plates at the end of their bones have closed in young adulthood, they won’t experience any further growth.
Ask your child’s doctor for more information about their specific condition, treatment plan, and outlook. They can help you understand your child’s chances of reaching their full height, as well as their risk of potential complications.
Early treatment may help a child with delayed growth reach an expected adult height, so it’s important to talk with your doctor as soon as you notice any signs or symptoms of delayed growth.
Treatment will depend on the underlying causes of your child’s delayed growth.