Growth Problems in Children

What are growth problems?

What causes growth problems?

Growth disorders can have many causes. Causes usually fall into one of the following groups:

• Familial short stature. This means a child is part of his or her family's pattern of inherited short height.
• Familial tall stature. This means a child is part of his or her family's pattern of inherited tall height. 
• Constitutional delay of growth and pubertal development. This means a child tends to be shorter than average and to enter puberty later than average, while growing at a normal rate. This may be inherited. These children tend to catch up in time and reach their normal adult height.
• Illnesses that affect the whole body (systemic diseases). This includes constant malnutrition, digestive tract diseases, kidney disease, heart disease, lung disease, diabetes, or chronic severe stress. Any of these conditions can cause growth problems.
• Endocrine (hormone) diseases. Growth can be affected by some conditions that disrupt hormones. Thyroid hormone is essential for normal bone growth. The pituitary gland at the base of the brain secretes several hormones, including growth hormone. Growth hormone deficiency can result from injuries to the pituitary gland or brain. Cushing syndrome can impair height but cause weight gain. Precocious puberty is a condition caused by hormone problems. It often causes fast growth and tall height compared with other children of the same age. But growth stops at an early age. As a result, children with precocious puberty may be short as adults.
• Intrauterine growth restriction (IUGR). This means growth of a baby in the uterus is slowed. This can be caused by many factors, such as smoking during pregnancy or not enough prenatal care. The baby is born smaller in weight and length than normal.
• Genetic disorders. This includes Turner syndrome, Down syndrome, and achondroplasia. Turner syndrome is when having too many, too few, or disrupted chromosomes result in health problems. It’s a common genetic disorder that occurs only girls. It causes poor growth and delayed or no puberty. Turner syndrome occurs in 1 in 2,500 girls. It’s caused by one missing X chromosome. Down syndrome is another common genetic disorder causing poor growth and short stature. It results from an extra 21st chromosome. Achondroplasia is the most common genetic bone disease. It causes a child’s arms and legs to be short. It also causes a large head and other features.

Most of these disorders that can cause growth problems are idiopathic. This means their cause is not known.

Who is at risk for growth problems?

Risk factors for growth problems include:

• Family history
• Systemic disease
• Genetic disorders

What are the symptoms of growth problems?

Most growth problems are noticed when the child appears smaller than his or her classmates, or when growth slows over several months. One main sign of a growth problem is when a child grows less than 3.5 cm (about 1.4 inches) a year after his or her 3rd birthday. In other cases, a baby may be abnormally small for his or her gestational age at birth.

Growth problems may be part of other problems or health conditions. Make sure your child sees his or her healthcare provider for a diagnosis.

How are growth problems diagnosed?

In some cases a growth problem may be diagnosed at birth, when a baby is abnormally small for his or her gestational age. In other cases, a growth problem may be diagnosed when a child's growth is checked during regular exams. 

Diagnosis of a growth disorder must be made by your child's healthcare provider. He or she may work with a pediatric specialist. The healthcare provider will ask about your child’s symptoms and health history. He or she may also ask about your family’s health history. He or she will give your child a physical exam. Your child's health and growth may be checked over several months.

Your child may also have tests, such as:

• Blood tests. These are done to check for hormone, chromosomal, or other disorders that can cause growth problems.
• X-ray. This test uses a small amount of radiation to make images of tissues inside the body. An X-ray may be done of the left hand and wrist. This can estimate your child's bone age. With delayed puberty or hormone problems, bone age is often less than calendar age. 

How are growth problems treated?

Many conditions that cause growth problems can be managed or corrected with medical treatment. Treatment for growth problems will be based on:

• What may be causing the growth problem
• How severe the problem is
• The child's current health and health history
• The child's ability to deal with medical procedures and take medicines
• The parents’ wishes about treatment

What are possible complications of growth problems?

Living with growth problems

Children who are shorter or taller than their peers may have poor self-esteem or depression. It’s important to talk about these problems with your child's healthcare provider. He or she can recommend support groups for you and your child.

Talk with your child's healthcare provider about your child's potential adult height. If your child's growth problems are caused by a condition that can be treated, work with your child's healthcare providers to create an ongoing plan to manage your child’s condition.

When should I call my child's healthcare provider?

Key points about growth problems

• A growth problem means that a child falls either below or above the average range of growth for a child's age, sex, family history, or racial background.
• Growth disorders have many causes. They can include genes, illness, or problems with hormones.
• Most growth problems are noticed when the child appears smaller than his or her classmates, or when growth slows over several months.
• One main sign of a growth problem is when a child grows less than 3.5 cm (about 1.4 inches) a year after his or her 3rd birthday. In other cases, a baby may be abnormally small for his or her gestational age at birth.
• Many conditions that cause growth problems can be managed or corrected with medical treatment.
• Children who are shorter or taller than their peers may have poor self-esteem or depression. It’s important to talk about these problems with your child's healthcare provider. He or she can recommend support groups for you and your child.

Next steps

• Before your visit, write down questions you want answered.
• At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you for your child.
• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.