Understanding Delayed Growth and How It’s Treated

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 smaller than 95 percent of children their age, and their rate of growth is slow.

A growth delay may also be diagnosed in a child whose height is in the normal range, but whose rate of growth has slowed.

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 they have low levels of the hormone thyroxine, they may have a loss of energy, constipation, dry skin, dry hair, and trouble staying warm.
• If they have low levels of growth hormone (GH), it can affect the growth of their face, causing them 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. 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 at a slower rate 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 normal rate. They usually have a delayed “bone age,” meaning their bones mature at a slower rate than their 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 is responsible for releasing hormones that promote normal 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 1 in 2,500 females. While children with TS produce normal amounts of GH, their bodies don’t use it effectively.

Other causes of delayed growth

Less common causes of delayed 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
• poor nutrition
• 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 six 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 relationship 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 about two-thirds of GH production happens while your child sleeps.

Also, delayed growth and small stature may sometimes be an expected part of a syndrome that your child has already been diagnosed with, such as Down syndrome or TS.

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 normally.

Growth hormone deficiency

If your child is diagnosed with a GH deficiency, their doctor may recommend giving them GH injections. The injections can usually be done at home by a parent, typically once a day.

This treatment will likely continue for several years as your child continues to grow. 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. Around age four to six, your child’s doctor may recommend starting daily GH injections to increase their likelihood of reaching normal adult height.

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 to their doctor about how you can help your child reach a normal 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 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.

Since early treatment may help your child reach a normal adult height, talk to your doctor as soon as you notice any signs or symptoms of delayed growth. Whether or not treatment is possible, identifying the underlying causes of your child’s delayed growth will help you determine how to proceed.