Lately, it seems as though your child is looking up to classmates — literally.
The other kids in the class have been getting taller and developing into young adults,
but your child's growth seems to be lagging behind. Classmates now tower over your
Is something wrong? Maybe, maybe not. Some kids just grow more slowly than others
because their parents did, too. But others may have an actual growth disorder, which
is any type of problem that prevents kids from meeting realistic expectations of growth, from failure
to gain height and weight in young children to short stature or delayed sexual development
Variations of Normal Growth Patterns
A couple of differences seen in the growth patterns of normal children include
these common conditions, which are not growth disorders:
Constitutional growth delay: This condition describes children
who are small for their ages but who are growing at a normal rate. They usually have
a delayed "bone age," which means that their skeletal maturation is younger than their
age in years. (Bone age is measured by taking an X-ray of the hand and wrist and comparing
it with standard X-ray findings seen in kids the same age.)
These children don't have any signs or symptoms of diseases that affect growth.
They tend to reach puberty later than their peers do, with delay in the onset of sexual
development and the pubertal growth spurt. But because they continue to grow until
an older age, they tend to catch up to their peers when they reach adult height. One
or both parents or other close relatives often had a similar "late-bloomer" growth
Familial (or genetic) short stature: This is a condition in which
shorter parents tend to have shorter children. This term applies to short children
who don't have any symptoms of diseases that affect their growth. Kids with familial
short stature still have growth spurts and enter puberty at normal ages, but they
usually will only reach a height similar to that of their parents.
With both constitutional growth delay and familial short stature, kids and families
need to be reassured that the child does not have a disease or medical
condition that poses a threat to health or that requires treatment.
However, because they may be short or may not enter puberty when their classmates
do, some may need extra help coping with teasing or reassurance that they will go
through full sexual development eventually. In a few children who are very short or
very late entering puberty, hormone treatment may be helpful.
Diseases of the kidneys, heart, gastrointestinal tract, lungs, bones, or other
body systems might affect growth. Other symptoms or physical signs in kids with these
illnesses usually give clues as to the disease causing the growth delay. However,
poor growth can be the first sign of a problem in some.
Growth disorders include:
to thrive, which isn't a specific growth disorder itself, but can be
a sign of an underlying condition causing growth problems. Although it's common for
newborns to lose a little weight in the first few days, failure to thrive is a condition
in which some infants continue to show slower-than-expected weight gain and growth.
Usually caused by inadequate nutrition or a feeding problem, it's most common in kids
younger than age 3. It may also be a symptom of another problem, such as an infection,
a digestive problem, or child
neglect or abuse.
Endocrinediseases (diseases involving hormones, the chemical messengers of
the body) involve a deficiency or excess of hormones and can be responsible for growth
failure during childhood and adolescence. Growth hormone deficiency
is a disorder that involves the pituitary gland (the small gland at the base of the
brain that secretes several hormones, including growth hormone). A damaged or malfunctioning
pituitary gland may not produce enough hormones for normal growth. Hypothyroidism
is a condition in which the thyroid gland fails to make enough thyroid hormone, which
is essential for normal bone growth.
one of the most common genetic growth disorders, occurs in girls and is a syndrome
in which there's a missing or abnormal X chromosome. In addition to short stature,
girls with Turner syndrome usually don't undergo normal sexual development because
their ovaries (the sex organs that produce eggs and female hormones) fail to mature
and function normally.
Diagnosing a Growth Disorder
The tests a doctor may recommend to detect a growth disorder depend on the findings
at each step of evaluation. A short child who's healthy and growing at a normal rate
may just be observed throughout childhood, but one who has stopped growing or is growing
more slowly than expected will often need additional testing.
Your doctor or an endocrinologist will look for signs of the many possible causes
of short stature and growth failure. Blood tests may be done to look for hormone and
chromosome abnormalities and to rule out other diseases associated with growth failure.
A bone age X-ray might be done and special scans (such as an MRI)
can check the pituitary gland for abnormalities.
To measure the ability of the pituitary gland to produce growth hormone, the doctor
(usually a pediatric endocrinologist) may do a growth hormone stimulation test. This
involves giving the child medications that cause the pituitary gland to secrete growth
hormone, then drawing several small blood samples over time to check growth hormone
Treating a Growth Disorder
Although the treatment of a growth problem usually isn't urgent, earlier diagnosis
and treatment can help some kids catch up with peers and increase their final height.
If an underlying medical condition is identified, specific treatment may result
in improved growth. Growth failure due to hypothyroidism, for example, is usually
treated with thyroid hormone replacement pills.
Growth hormone injections for children with growth hormone deficiency, Turner syndrome,
and chronic kidney failure may help kids reach a more normal height. Human growth
hormone is generally considered safe and effective, although full treatment may take
many years and not all kids will have a good response. And the treatment can be costly
(about $20,000 to $30,000 per year), although many health insurance plans cover it.
What about growth hormone treatment for short children who aren't growth hormone
deficient when tested? The U.S. Food and Drug Administration (FDA) has approved its
use in such children if they're predicted to reach a very short final height (under
4 feet 11 inches [150 centimeters] for a girl; under 5 feet 4 inches [163 centimeters]
for a boy).
Talk with your doctor for more information about treatment options if you're concerned.
Helping Your Child
You can boost your child's self-esteem
by providing positive reinforcement and emphasizing other characteristics, like intelligence,
personality, and talents. Try to take the focus off of height as a measure of social
Kids who are very self-conscious about their size might need help in coping. In
some cases, evaluation and treatment by a mental health professional may be needed.
If You Suspect a Problem
If you're concerned about your child's growth, speak with your doctor, who may
refer you to a pediatric endocrinologist, who can help diagnose and treat specific
It's also important to watch for the social and emotional problems that kids with
growth disorders face. It's not easy being the shortest kid in the class and it's
never any fun being teased. Helping your child build self-esteem and emphasizing strengths
— regardless of how tall he or she may grow — might be just what the doctor