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If you are worried about a child's growth, the most useful thing you can do is talk to their paediatrician or family doctor. That is true whether the worry is height, weight, the timing of puberty, or a sense that something has changed. Doctors can measure accurately, look at the child's growth over time, examine them and decide whether anything needs testing. A website, including this one, cannot do any of that.
This guide explains which signs the health agencies treat as worth raising and what an assessment can involve, so that the conversation is less daunting. It does not offer diagnosis or treatment advice.
Signs worth raising
Drawing on guidance from the NHS, MedlinePlus and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), these are reasons to book an appointment:
- A child is not growing as expected for their age. The NHS gives this as the reason to see a GP about restricted growth.
- Growth seems to have slowed down. MedlinePlus lists a slowed growth rate compared with children of the same age and sex as a symptom of growth hormone deficiency.
- A child is much shorter, or much taller, than others of the same age and sex. MedlinePlus notes that very slow or very fast growth can sometimes signal a gland problem.
- Puberty starts very early. NICHD defines precocious puberty as starting before age 8 in girls or before age 9 in boys, and notes that it can stop growth too soon.
- Puberty seems late. NICHD describes delayed puberty as starting later than the normal range, which it gives as roughly 8 to 13 in girls and 9 to 14 in boys.
Weight matters too. MedlinePlus describes faltering weight, where a child does not gain weight or grow as expected, and advises talking to a provider if you are worried about a child's growth or diet.
Short is often normal
Before the causes, a reassurance the sources are keen to give. MedlinePlus says a child who seems much shorter or taller than others of the same age may well be normal: some children are small for their age but still developing normally, and some are short or tall because their parents are. The NHS says restricted growth is usually genetic, and that this can simply be because the parents are short.
Raising a concern is not the same as expecting bad news. Often the outcome of an assessment is confirmation that a child is growing in line with their family. That is still a useful answer, and it can save a family from worrying, or from spending money on products that cannot help.
Medical causes doctors look for
When a child's growth is not following the expected pattern, doctors look for causes they can identify and, in some cases, treat. The sources mention several groups:
- Hormone problems. MedlinePlus explains that the pituitary gland makes growth hormone and that children with too little of it may be very short. Too much growth hormone, usually from a non-cancerous pituitary tumour, can cause excessive growth.
- Genetic conditions. The NHS lists rare genetic conditions such as Turner syndrome, Noonan syndrome and Prader-Willi syndrome among causes of restricted growth.
- Problems with bone development. The NHS includes skeletal dysplasias, such as achondroplasia.
- Nutrition. The NHS names poor diet (malnutrition) as a possible cause, and NICHD lists poor nutrition among causes of delayed puberty.
- Puberty timing. NICHD notes that early puberty can stop growth too soon, and that delayed puberty can reflect family history, nutrition or an underlying medical condition.
This list is for orientation only. It is not a checklist to diagnose a child at home, and many of these conditions are rare.
What an assessment can involve
An assessment usually starts with accurate measurements, plotted on a growth chart, and questions about the child's health and the family. The CDC stresses that growth charts contribute to an overall clinical impression and are not meant to be used as the only basis for a diagnosis.
If a doctor thinks more investigation is needed, the NHS says tests can include blood tests, genetic tests and X-rays. NICHD says that, for suspected early or late puberty, a provider will examine the child, go through the medical history and may then do tests.
When a growth hormone problem is suspected, MedlinePlus explains that a single ordinary blood test is not much use, because growth hormone levels change through the day. Instead, doctors may use a growth hormone stimulation test. In outline, the child has a series of blood samples taken over about two hours after being given a medicine through a drip that prompts the pituitary gland to release growth hormone; the samples show whether levels rise as expected. MedlinePlus also mentions a blood test for IGF-1, a related hormone whose level is steadier through the day. These tests are arranged and interpreted by doctors; this is a description to help families know what to expect, not a guide to requesting them.
Why early matters
MedlinePlus notes that when growth hormone deficiency is diagnosed and treated early, some children grow several inches in the first year of treatment. Others grow more slowly but still benefit. Raising a concern sooner rather than later keeps options open.
Treatment is a specialist decision
Treatment depends entirely on the cause, and decisions about it are made by specialists. This site does not give treatment advice. In broad terms, the sources describe:
- Growth hormone medicine for some children. The NHS calls it the main treatment for restricted growth and says it is used to increase height in children with restricted growth or who are not growing as expected. It also says how well treatment works depends on the cause, and that it is not normally used for problems of bone development such as achondroplasia. MedlinePlus says treatment can stimulate growth in children who have too little growth hormone.
- Treatment for early puberty, which NICHD says can pause puberty until the child is closer to the usual age.
- Treatment of an underlying problem, such as a nutritional shortfall or another medical condition.
The NHS also notes that outcomes vary: with treatment, some people with restricted growth conditions reach an average or near-average adult height, while others remain well below average. Anyone offered treatment should expect a specialist to explain the likely benefits and risks for that particular child.
The emotional side
Height can weigh on children and teenagers, especially if they are teased or feel different from friends. The NHS notes that support is available from health professionals and from charities for people with restricted growth and their families. NICHD notes that children with early puberty can feel anxious about being different, although many do not have major problems.
Whatever the cause, it helps to keep the focus on a child's health and strengths rather than on a number. Being shorter than average is not a medical problem in itself.
And if you are an adult?
If you have finished growing and are unhappy with your height, there is no treatment described by the health agencies this site relies on that will make you taller, because the growth plates in your long bones have closed. The guide to how growth works explains why. If your height seems to be decreasing, or you have developed a stoop or back pain, that is a reason to see a doctor, as the guide on posture and height loss explains.