Physical growth is an essential part of childhood. A child’s most dramatic growth occurs in three periods:
- Before birth, when the child is a fetus
- During the first few years of life
- During puberty
Each child grows at an individual rate. The rate is influenced by heredity, gender, environmental factors and nutrition. Other factors can also affect and even severely slow growth. Sometimes, a medical condition stops a child from growing at a normal rate. For example:
- Hormone deficiencies
- Intestinal disorders
- Kidney, lung or heart diseases
- Bone disorders
- Diabetes or other blood sugar disorders
- Any severe form of a disease, severe stress or emotional trauma
Note that a growth problem is different than failing to thrive. A child with symptoms indicating failure to thrive needs care from specialists in gastroenterology and nutrition. If your child has stopped gaining weight, is below the normal percentile for weight or has lost weight, your pediatrician may refer you to these specialists.
Growth problems are treated by the Division of Endocrinology.
Growth involves not just the length and weight of a body, but also internal growth and development. A child's brain grows the most during the first five years of life, reaching 90% of its final size. Growth also affects different parts of the body at different rates. For example, the head reaches almost its entire size by a child’s first birthday. Throughout childhood, a child's body becomes more proportional to other parts of the body. Growth is typically complete between 16 and 18 years of age.
- Height, weight and head circumference: Height, weight and head circumference are important measurements of a child's growth.
- Growth chart: During healthcare visits, these three measurements are plotted on a growth chart. The growth chart helps healthcare providers see how closely the child’s measurements match normal for age. It also shows if the child is growing normally from visit to visit. If you suspect your child isn’t growing properly, always consult your pediatrician.
You can view growth charts
from the U.S. Centers for Disease Control and Prevention.
Small Stature Causes
Some growth problems are genetic, while others may be caused by hormonal disorders or poor absorption of food. Causes for growth problems usually fall into three categories:
Genetic Short Stature
This is the most common reason for short stature. Short stature is most often familial, meaning the child has inherited short height from one or both parents. Other genetic causes for short stature include abnormal bone development and some syndromes, including Down, Turner, Noonan and Prader-Willi.
Constitutional Growth Delay with Delayed Adolescence or Delayed Maturation
Children who are shorter than average for their age and begin puberty later than average may have a growth delay, but not a disorder. Most of these children eventually grow to about the same height as their parents. A key distinction between a short child with a growth delay and a short child with a growth disorder is that the rate of growth in a child with growth delay is usually normal (at least two inches a year).
Abnormal (or Attenuated) Growth
Illnesses that affect the whole body (also called systemic diseases) that may cause growth problems include constant malnutrition, digestive tract diseases, kidney disease, heart disease, lung disease, uncontrolled diabetes and severe stress. Some children are abnormally small at birth and don’t catch up. Endocrine disorders that may result in abnormal growth include the following:
- Untreated hypothyroidism
- Growth hormone deficiency
- Absence of puberty
- Excess cortisol hormone production
Effect on Child
Often, children who are noticeably short are treated and thus behave like younger, less mature children. As children get older, those with delayed or limited growth may lose confidence and be emotionally hurt. Some are teased or bullied. Building healthy self-esteem helps children cope with these challenges.
Children who are short face difficulties in ordinary life (for example, reaching door handles and the drinking fountain at school, sitting at common tables and riding in cars). They see that their peers don’t face the same obstacles. Parents can learn ways to give the right support at home, at school and in social interactions. Family, friends and teachers who are realistic, positive and affectionate help promote self-confidence in children and adolescents.
Diagnosis & Treatment
A few growth problems can be diagnosed shortly after birth. Most growth problems aren’t noticed until much later, when the child appears smaller than classmates or when growth is less than expected.
- After the age of three and up until puberty, a child should generally grow at least two inches a year.
A slower growth rate should be evaluated to see what is causing it. If a child isn’t growing normally, the doctor may order a hand x-ray (called a bone age) to determine bone maturation and growth potential, blood tests and a consultation with a pediatric endocrinologist.
If your pediatrician is concerned about your child’s growth and suggests seeing an endocrinologist, don’t wait too long. Delaying treatment can significantly reduce your child’s final height.
A pediatric endocrinologist is trained to understand the complexity of conditions affecting growth and hormones. We usually see children who are between four and eight years old. Timely treatment allows for better recovery of growth. Getting help can relieve the child of many physical and emotional challenges.
Always consult your pediatrician if you feel your child isn’t growing normally.
The First Visit
During the first visit, we gather information on your child’s growth and what may affect it.
- Patient and family history: We take a careful history. We ask about illnesses and diseases, the pregnancy and birth, feeding during infancy and medications the child takes.
- Growth and medical records: To make the most of this visit, bring a complete copy of your child’s medical records. The growth records from birth to present are very important. If you have changed pediatricians, be sure your child’s records are complete.
- Physical exam: We do a complete exam. We measure and weigh the child and sometimes measure the height of both parents (it is best if both parents attend so we can get the most accurate family history).
- Diagnostic tests: The doctor determines if blood tests and an x-ray of the hand (to determine the child’s bone age) would be helpful.
- Care plan: You leave with a clear idea of the next steps of the diagnostic process, including when to expect test results. Usually, the doctor wants you to return in about four months to monitor growth.
Collaborating and communicating with the child’s primary care provider is an important part of our work. For each child, we develop and help families follow an individualized care plan.
Our pediatric endocrinologists
have extensive training and experience in diagnosing and treating growth problems. We also have knowledgeable endocrinology nurses on our team. As needed, we can lead you to excellent sources for psychosocial support. In our family-friendly care settings, you’ll see that our team is attuned to the needs of children, teens and families. Our doctors understand the physical and emotional challenges that go along with growth problems. Their sensitivity to these issues helps provide the best outcome for your child.
Learn more about growth problems by reviewing the following physician-recommended resources: