If your child isn’t growing at the normal rate for their age, they have a growth delay. You may notice it yourself or their doctor may notice it during a routine exam. Their growth delay may occur due to an underlying health condition. In some cases, early treatment can help them reach a normal or near normal height.

If you suspect your child isn’t growing at a normal rate, make an appointment with their doctor. It may be a sign of other problems.

If your child is smaller than other children their age, they may have a growth problem. It’s typically considered a medical issue if they’re the same size as children who are two or more years younger than they are, particularly if their rate of growth is slow as well.

Depending on the underlying cause of their growth delay, they may have other symptoms:

  • If they have certain forms of dwarfism, the size of their arms or legs may be out of normal proportion to their torso.
  • If low levels of the hormone thyroxine are causing their growth delay, they may experience a loss of energy, constipation, dry skin, dry hair, and trouble staying warm.
  • If they have low levels of GH, it can affect the growth of their face, causing your child to look abnormally young.
  • If their delayed growth is caused by stomach or bowel disease, they may have blood in their stool, diarrhea, constipation, vomiting, or nausea.

Delayed growth can have a wide variety of causes, including:

  • a family history of growth delays
  • smaller birth and fetal weight
  • low levels of GH
  • low levels of thyroxine due to hypothyroidism
  • Turner syndrome, which is a genetic condition that affects females who are missing some or all of one X chromosome
  • Down syndrome, which is a genetic condition in which individuals have 47 chromosomes instead of the usual 46
  • skeletal dysplasia, which is 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
  • the use of certain drugs by their birth mother while she was pregnant
  • poor nutrition
  • severe stress

Your child’s doctor will likely 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
  • their length and weight at birth
  • the heights of other people in their family
  • information about other family members who’ve experienced growth delays

Their doctor may also chart your child’s growth for six months or more.

Certain tests and imaging studies can also help their doctor develop a diagnosis. A hand and wrist X-ray can provide important information about your child’s bone development in relationship to their age. Blood tests can pick up problems with hormone imbalances or help detect certain diseases of the:

  • stomach
  • bowel
  • kidney
  • bone

In some cases, the doctor may ask your child to stay overnight in the hospital for blood testing because about two-thirds of growth hormone (GH) production happens while your child sleeps.

In some cases, delayed growth and small stature may 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. Treating the underlying causes may help them start growing normally.

For example, if your child is diagnosed with a GH deficiency, their doctor may recommend giving them injections of GH at home. They may ask you to give them shots three times per week or as often as every day. This treatment will likely continue for several years as your child continues to grow.

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 normal or near normal 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 a normal height, as well as their risk of potential complications.