Lately, it seems as though your child is looking up to classmates - literally. The other kids in the class have been getting taller and developing into young adults, but your child's growth seems to be lagging behind. Classmates now tower over your child.

Is something wrong? Maybe or maybe not. Some kids may just grow more slowly than others simply because their parents did, too. But other children may have an actual growth disorder. This can be any type of problem in infants, kids, or teens that prevents them from meeting realistic expectations of growth, from failure to gain height and weight in young children to short stature or delayed sexual development in teens.

Variations of Normal Growth Patterns in Children
A couple of differences seen in the growth patterns of normal children include these common conditions, which are not growth disorders:

Constitutional growth delay: This condition describes children who are small for their ages but who are growing at a normal rate. They usually have a delayed "bone age," which means that their skeletal maturation is younger than their age in years. (A child's bone age is measured by taking an X-ray of a child's hand and wrist and comparing it to standard X-ray findings seen in children of the same age.) These children don't have any signs or symptoms of diseases that affect growth. They tend to reach puberty later than their peers do, with delay in the onset of sexual development and the pubertal growth spurt. But because they continue to grow until an older age, they tend to catch up to their peers when they reach adult height. One or both parents or other close relatives of these children often experienced a similar "late-bloomer" growth pattern.

Familial (or genetic) short stature: This is a condition in which shorter parents tend to have shorter children. This term applies to short children who don't have any symptoms of diseases that affect their growth. Children with familial short stature still have growth spurts and enter puberty at normal ages, but they usually will only reach a height similar to that of their parents.

With both constitutional growth delay and familial short stature, children and families need to be reassured that the child does not have a disease or medical condition that poses a threat to health or that requires treatment. However, because they may be short or may not enter puberty when their classmates do, some kids with these growth patterns may need extra help coping with teasing by their peers, or they may need reassurance that they will go through full sexual development eventually. In a few normal children who are very short or very late entering puberty, hormone treatment may be helpful.

Growth Disorders
Diseases of the kidneys, heart, gastrointestinal tract, lungs, bones, or other body systems may affect growth. Other symptoms or physical signs in children with these illnesses usually give clues as to the disease causing the growth delay. However, poor growth may be the first sign of a problem in some of these conditions.

Here are a few examples of growth disorders:

Failure to thrive isn't a specific growth disorder itself, but it can be a sign of an underlying condition causing growth problems. Although it's common for newborns to lose a little weight in the first few days, failure to thrive is a condition in which some infants continue to show slower-than-expected weight gain and growth. Usually caused by inadequate nutrition or a feeding problem, failure to thrive is most common in children younger than age 3. It may also be a symptom of another problem, such as an infection, a digestive problem, child neglect, or abuse.

Endocrine diseases (diseases involving hormones, the chemical messengers of the body) involve a deficiency or excess of hormones and can be responsible for growth failure during childhood and adolescence. Growth hormone deficiency is a disorder that involves the pituitary gland (the small gland at the base of the brain that secretes several hormones, including growth hormone). A damaged or malfunctioning pituitary gland may not produce enough hormones for normal growth. Hypothyroidism is a condition in which the thyroid gland fails to make enough thyroid hormone, which is essential for normal bone growth.

Turner syndrome, one of the most common genetic growth disorders, occurs in girls and is a syndrome in which there's a missing or abnormal X chromosome. In addition to short stature, girls with Turner syndrome usually don't undergo normal sexual development because their ovaries (the sex organs that produce eggs and female hormones) fail to mature and function normally.

How Is a Growth Disorder Diagnosed?

The tests a doctor may recommend to detect a growth disorder depend on the findings at each step of evaluation. A short child who's healthy and growing at a normal rate may just be observed throughout childhood, but a child who has stopped growing or is growing more slowly than expected will often need additional testing.

Your child's doctor or endocrinologist will look for signs of the many possible causes of short stature and growth failure. Blood tests may be performed to look for hormone and chromosome abnormalities as well as to rule out other diseases associated with growth failure. A bone age X-ray is frequently done, and special scans (such as an MRI) can check the pituitary gland for abnormalities.

To measure the ability of the child's pituitary gland to produce growth hormone, the doctor (usually a pediatric endocrinologist) may perform a growth hormone stimulation test. This involves giving the child certain medications that cause the pituitary gland to secrete growth hormone and then drawing several small blood samples to check growth hormone levels over a period of time after the medications are given.

How Is a Growth Disorder Treated?
Although the treatment of a growth problem usually isn't an urgent situation, earlier diagnosis and treatment of some conditions may help kids catch up with peers and increase the final height they attain.

If an underlying medical condition is identified, specific treatment may result in improved growth. Growth failure due to hypothyroidism, for example, is usually simply treated by giving the child thyroid hormone replacement therapy in pill form.

Growth hormone injections for children with growth hormone deficiency, Turner syndrome, and chronic kidney failure may help children with these conditions reach a more normal height. Human growth hormone is generally considered safe and effective, although full treatment may take many years and not all children will have a good response. And the treatment can be quite costly (approximately $20,000 to $30,000 per year), although most health insurance plans will cover the costs.

What about growth hormone treatment for short children who aren't growth hormone deficient when tested? The Food and Drug Administration (FDA) has approved the use of growth hormone therapy for nongrowth hormone deficient children who are predicted to reach a very short final height (under 4 feet 11 inches [150 centimeters] for a girl or 5 feet 4 inches [163 centimeters] for a boy). Talk with your child's doctor for more information about this and other treatment options if you're concerned.

How Can I Help My Child?
You can boost your child's self-esteem by providing positive reinforcement and emphasizing other characteristics, like intelligence, personality, and talents. Try to de-emphasize the focus on height as a measure of social acceptance.

Kids who are very self-conscious about their size may need some additional help in coping. In some cases, evaluation and treatment by a mental health professional may be needed.

What Do I Do if I Suspect a Problem?
If you're concerned about your child's growth, visit his or her doctor. Depending on the findings of the examination, the doctor may refer your child to a pediatric endocrinologist, who can help diagnose and treat specific growth disorders.

It's also important to be on the lookout for the social and emotional problems that kids with growth disorders face. It's not easy being the shortest kid in the class and it's never any fun being teased. Helping your child build self-esteem and emphasizing his or her abilities - regardless of how tall he or she may grow - might be just what the doctor ordered.

Reviewed by: Steven Dowshen, MD
Date reviewed: January 2005