Growth Failure in Children

Growth Failure in Children Overview

Growth failure is a term used to describe a growth rate that is below the appropriate growth velocity (speed) for age. The term growth delay may refer to a situation in which a child is short but appears to be able to grow longer than children usually do, and thus, may not end up short as an adult. Dwarfism is a term that has often been used to describe extreme short stature; however, the term is unflattering and its use is often avoided. Growth hormone deficiency is sometimes called pituitary dwarfism. Short stature may be a normal expression of a person's genetic potential and, therefore, the growth rate is normal. Short stature may also be a result of a condition that causes growth failure and a growth rate that is slower than normal. A child is considered to be short if he or she has a height below the 3rd or 5th percentile on a growth chart. About 3%-5% percent of all children are considered to be short. However, many of these children have normal growth velocities. The children who fall into this group include those with familial short stature or constitutional growth delay. Those with familial short stature are born with genes that determine their short height, and they usually have parents who are short. Constitutional growth delay is a term used to describe children who are small for their age but who have a normal growth rate. Of all children with short stature, only a few have a specific treatable medical condition. The most rapid phase of growth occurs in the mother's uterus. After birth, the growth rate gradually declines over the first several years of life. At birth, the average length of a newborn is 20 inches; at 1 year, the average height is about 30 inches; at 2 years, the average height is about 35 inches; and at 3 years, the average height is about 38 inches. After 3 years and until puberty, linear growth continues at a relatively constant rate of 2 inches per year.

Growth Failure in Children Causes


Normal growth is the result of several factors, such as nutrition, genetics, and hormones. The following are possible causes of growth failure.

·         Familial short stature: Children with this condition have parents with short stature. They have a normal growth velocity, and bone age is not delayed. They enter puberty at a normal time and often complete growth with a short adult height.

·         Constitutional growth delay: Also called delayed puberty, children with constitutional growth delay have a normal birth weight, and their growth slows usually during the first year of life. From about age 3 to puberty, these children have an adequate growth velocity. Bone age is usually delayed, and puberty is late. Late puberty allows for more prepubertal growth, usually resulting in a normal adult height. Usually, children with constitutional growth delay do not show growth failure but a period of slow growth velocity occurs during the first year of life and just before puberty.

·         Malnutrition: Worldwide, malnutrition is probably the most common cause of growth failure and is usually poverty-related. Nutritional deficiencies in developed countries are more often the result of self-restricted diets. Poor weight gain is often more noticeable than short stature.

·         Diseases and disorders: Chronic diseases and systemic disorders that involve the nervous, circulatory, or gastrointestinal systems may be a cause of growth failure. Diseases or disorders involving the liver, kidneys, lungs, or connective tissue may also be a cause.


·         Psychosocial dwarfism: This is a disorder of short stature or growth failure and/or delayed puberty. This often occurs in association with emotional deprivation and/or child abuse and neglect.

·         Syndromes: Growth failure can be a feature of genetic syndromes, such as Turner syndrome and Down syndrome. It can also be a part of other syndromes, such as Noonan syndrome, Russell-Silver syndrome, and Prader-Willi syndrome.

·         Endocrine (hormonal): Endocrine causes include thyroid hormone deficiency (hypothyroidism), growth hormone deficiency, or other hormone disorders. Thyroid hormone is necessary for normal growth; in children with hypothyroidism, growth is extremely slow. Children with growth hormone deficiency have normal body proportions, but they may appear younger than their actual age.

·         Other: Growth failure may be related to intrauterine growth retardation (a condition in which children weigh less than 5 pounds at full term or who are small for gestational age if born preterm). Bone and cartilage disorders (called chondrodystrophies) may also be a cause of growth failure. Achondroplasia (one of the most common conditions that cause growth failure and short stature) is a genetic disorder of bone and cartilage. People with achondroplasia have a normal-sized trunk, short arms and short legs, and a slightly enlarged head with a prominent forehead. Adults with this condition are typically about 4 feet tall. There are other chondrodystrophies, such as hypochondroplasia, which are similar to achondroplasia but not as severe.

Symptoms of Growth Failure in Children

Symptoms of growth failure may include the following:

·         The child's height, weight, and head circumference do not progress normally according to standard growth charts.

·         Physical skills, such as rolling over, sitting up, standing, or walking, are slow to develop.

·         Social and mental skills are delayed.

·         The development of secondary sexual characteristics (for example, men's facial hair, women's breasts) is delayed in adolescents.

When to Seek Medical Care


See your doctor or health-care practitioner if you are concerned about your child's growth

Exams & Tests


The doctor or health-care practitioner will measure the child's weight and height. He or she may also ask about the child's birth weight and birth height. The doctor may use the parents' heights to calculate the child's projected potential adult height. The doctor may also want to know the timing of puberty in the parents. The doctor may take measurements of the limbs and trunk to determine the child's body proportions.
The doctor may perform blood tests to check for hormones and to rule out specific syndromes associated with growth failure. The following blood tests may be performed:

·         Thyroxin and thyroid-stimulating hormone tests,

·     Serum electrolyte levels,

·         Complete blood count and sedimentation rate,

·         Insulin-like growth factor 1 and insulin-like growth factor -- binding protein 3 tests, or a

·         Growth hormone stimulation test.

An MRI of the head may be indicated in children with growth hormone deficiency to rule out a brain tumor. X-rays may be taken of the left wrist to compare with standard charts. This image can also be used to determine the child's bone age and growth potential.


Next Steps


The doctor or health-care practitioner may want to evaluate the child every three months while the cause of growth failure is being investigated. This also allows the doctor to obtain repeated growth measurements, which can then be used to estimate the child's growth rate. The doctor may refer the child to a pediatric endocrinologist (a doctor who specializes in studying hormones) for a more detailed evaluation of the possible causes of growth failure.


Routine well-baby checkups and periodic checkups for school-age and adolescent children is the best means of prevention.


Early therapeutic intervention is important. Therapy should begin before the child's growth process is complete. For children with hypothyroidism or growth hormone deficiency, hormone replacement therapy usually results in a period of rapid catch-up growth, with subsequent normal growth until the growth process is complete.