Growth Delay or Disorder

What is normal growth?

Growth patterns in children vary. For example, baby boys grow faster than girls until about 7 months. After that, girls grow faster until about age 4. The growth rate then becomes the same for both until puberty.

A child's size depends a great deal on their parents. Large parents usually have large children. Small parents, as a rule, have small children. A short child, who has short parents, does not necessarily have a growth problem. While these children will have growth spurts and enter puberty at normal ages, they will usually only reach a height similar to that of their parents.

What is a growth delay or disorder?

Nutrition, genetics, and hormones can all affect growth patterns. When a child's growth seems to be lagging behind, the cause may be a natural growth delay or be caused by a growth disorder. A child with a growth delay may still go through all other development stages normally.

What is the cause?

There are several possible causes for growth problems.

• Normal delayed growth: If your child is growing at a normal rate, yet is small for his or her age, it is called a constitutional growth delay. Your child may have a delayed bone age, which means your child's bones are a younger age than your child's age in years. Puberty may be delayed until bone growth catches up. Often one or both parents or a relative has experienced a similar late-bloomer type of growth pattern.
• Failure to thrive: When children younger than age 3 do not gain weight or grow as expected, it may be a condition known as failure to thrive. It is usually caused by a feeding problem or inadequate nutrition. Malnutrition is the most common cause of growth failure around the world. Failure to grow may also be a symptom of another problem, such as an infection, a digestive condition, or even child neglect or abuse.
• Hormone problem: A condition that causes too much or too little of one or more hormones can cause growth problems during childhood and teen years. A failure of the thyroid gland to make enough thyroid hormone, which is essential for normal bone growth, is called hypothyroidism. If the pituitary gland is damaged or malfunctioning, it may not be able to produce enough hormones for normal growth.
• Chronic illness: Chronic illnesses are another common cause of delayed or slower growth. Growth can be slowed by illnesses like asthma, congenital heart disorders, chronic kidney failure, and poorly controlled diabetes. Children with neuromuscular diseases such as spinal muscular dystrophy, cleft palate, or some psychosocial problems may not get enough to eat. Some diseases such as diabetes, cystic fibrosis, heart failure, and HIV interfere with the body's use of nutrients.
• Other problems: Other disorders that may cause slow growth include genetic disorders (for example, Turner Syndrome), infections during pregnancy, and use of certain medicines, alcohol or cigarettes during pregnancy.

How is it diagnosed?

Regular recordings of the child's height and weight are used to check the child's growth rate. Parents who suspect that their child has a growth problem should take their child to a healthcare provider for an exam. You may suspect a growth problem if:

• your child's height or weight are less than you think they should be
• your child is slow to develop skills such as sitting up, walking, or speaking
• your teen seems slow in reaching puberty (such as girls developing breasts or boys developing facial hair).

Your child may have blood tests to check the functioning of many organs. Special tests may be ordered to check hormone levels. Your child may also need to have an X-ray of his or her wrist to measure bone growth and age. Occupational therapists may also watch your child's feeding behavior.

How is it treated?

Treatment for growth delay depends on the cause. Malnourished children may need high calorie supplements. Shots or pills of the hormone may help a hormone shortage.

Children often compare themselves to their friends. This comparison can be a source of much distress to a child and his or her parents. It is important that a child's concern not be dismissed as unimportant.

When should I call my child's healthcare provider?

If you are concerned about your child's growth, call during office hours to schedule an appointment with your healthcare provider to review your child's growth history. If you have medical records that include your child's height and weight (including birth records), bring them to a visit.