Children's Hospital Colorado

Short Stature and Growth Disorders

What is short stature?

Short stature means that a child is shorter than 95% to 97% of other children of the same age and sex. If your child is growing at a normal rate, this is not necessarily a concern. Most children who have short stature but a normal growth rate show no medical problem. They may have parents who are short and inherit that trait. We call this "familial" short stature.

However, some children with short stature show below-average growth over the course of a year. They may also fall farther behind other children their age as they get older. This can be a sign of a growth problem.

Typical growth is:

  • About 10 inches from age 0 to 1
  • About 5 inches from age 1 to 2
  • About 3.5 inches from age 2 to 3
  • About 2 inches per year from age 3 until puberty

If you are concerned about your child's height, we can provide an evaluation.

What causes growth disorders in children?

Growth disorders often result from other health conditions. We can treat many of these conditions so your child can grow to a typical adult height. These include:

  • Conditions that a child is born with, such as intrauterine growth restriction, which causes babies to be born smaller than average
  • Nutritional deficiencies, sometimes called failure to thrive, which can cause babies to have a very low weight compared to their length
  • Malnutrition from not eating enough healthy foods, or having difficulty absorbing or using food
  • Endocrine diseases that affect hormone production like hypothyroidism, diabetes and growth hormone deficiency
  • Delayed puberty, which causes children to mature slower than their peers
  • Early puberty, which causes an early growth spurt and early end to growth
  • Genetic disorders and chromosome abnormalities such as Down syndrome, Turner syndrome and Prader-Willi syndrome
  • Bone problems like achondroplasia, which is a form of dwarfism
  • Serious asthma, because of the medicines used to manage it
  • Chronic conditions such as cystic fibrosis, diabetes, celiac disease, or other health problems that affect digestion

In other cases, short stature may run in families or there may not be a known cause.

There are also some conditions that can cause tall stature, such as Klinefelter syndrome and Marfan syndrome.

What is growth hormone deficiency?

Growth hormone deficiency is one of the most treatable causes of short stature in children. It happens when the pituitary gland does not produce enough growth hormone or it produces no growth hormone at all. The pituitary gland is attached to the base of the brain, just below the area called the hypothalamus. The hypothalamus controls the pituitary gland.

Growth hormone deficiency can occur if there is a problem with the pituitary gland or hypothalamus or if they get damaged. A deficiency can also happen for unknown reasons. We can treat children with growth hormone deficiency to help them grow, as long as we start before or during the early stages of puberty. Growth typically ends around 14 years old in girls and around 17 years old in boys. However, their age when they started puberty can impact this timing.

Who gets growth disorders?

Short stature can happen at any age. In young children, we often discover it during a routine health exam. We will notice it when we record your child's measurements for height, weight and head size. If the measurements fall outside the typical range for your child's age and sex, we may recommend further evaluation.

Older children often notice their short stature when they approach puberty and see their friends surpassing them in height and physical maturity. Puberty usually begins between ages 8 to 13 for girls and ages 9 to 14 for boys. It should include a growth spurt. If children aren't experiencing puberty and a growth spurt during that time, we recommend an evaluation.

What are the signs and symptoms of short stature and growth disorders?

Short stature and growth disorder symptoms can include:

  • Height significantly below average for your child's age and sex; below at least the third or fifth percentile on a pediatrician's growth chart
  • Late development of physical and mental skills
  • Growth of less than about 2 inches per year after age 3
  • Delayed puberty

How do doctors diagnose short stature and growth disorders in children?

We will take a medical history, do a physical exam and monitor your child's growth for a period of time. This will show us whether their height and growth rate are within a typical range. If their height is below this range, we may assign a short stature diagnosis. If their growth rate is also below this range, we may assign a growth disorder diagnosis.

Further evaluation may include:

  • A review of your child's prenatal, labor and delivery records
  • A review of the heights of the parents
  • Blood testing to check for anemia and other disorders associated with growth problems
  • A comprehensive metabolic profile to check your child's kidney, liver and bone metabolism
  • A urine test to check how well your child's kidneys work
  • A blood test to check your child's ability to produce thyroid hormone
  • Measurement of insulin-like growth factor-1 (IGF-1) and insulin-like growth factor binding protein-3
  • An X-ray of your child's hand and wrist to estimate their bone maturity and predict their remaining growth potential
  • An MRI to check your child's pituitary gland and hypothalamus
  • A growth hormone stimulation test, using medicines to stimulate hormone production and an IV (intravenous line) to draw small blood samples every 30 minutes over several hours

How are short stature and growth disorders treated?

Short stature treatment depends on the underlying cause of the condition. It also depends on your child's age, health and medical history. Often, all children need is close observation of their growth and development.

During growth disorder treatment, we work with families to develop a plan. For cases caused by malnutrition, we provide nutritional therapy. For cases caused by endocrine conditions, we replace the missing thyroid, growth or puberty hormones.

When your child has a growth hormone deficiency, we provide injections of human growth hormone daily or several times per week. This may continue for several years. Rarely, for some children with low IGF-1 levels, we may instead provide injections of synthetic human IGF-1.

Growth hormone treatment isn't right for everyone. It is appropriate for children who:

  • Have growth hormone deficiency
  • Are awaiting kidney transplantation and have chronic renal insufficiency
  • Have Turner syndrome, Noonan syndrome or Prader-Willi syndrome
  • Have severe short stature that inhibits their daily activities
  • Were born small for their gestational age and have not caught up to the growth curve by 2 years of age

Some children may experience side effects from growth hormone injections, especially if they don't have growth hormone deficiency. We will discuss these side effects with your family before starting therapy. The sooner children begin treatment, the more likely they are to grow to a typical adult height.

Why choose Children's Hospital Colorado for your child's growth disorder treatment?

Our Department of Pediatric Endocrinology treats your child as an individual. We evaluate all their physical, radiology and laboratory findings to consider the best solutions for their unique needs.

Once all necessary testing is complete, we meet with your family to discuss your child's condition and outlook. We then work together to select a treatment plan based on our findings and on your preferences as a family.

Our approach may involve experts in genetic disorders, nutrition, adolescent medicine and more, depending on your child's needs.

We offer a full range of medical, radiologic and surgical therapies. We also have nursing and medical support available for our patients 24 hours a day, 7 days a week.