Growth Concerns in Children

What are growth concerns?

Every child grows at their own pace, but a child who is significantly shorter than their peers or whose growth has slowed unexpectedly may benefit from assessment by a paediatric endocrinologist. Although many children are naturally smaller because of family genetics, some growth concerns can be caused by underlying medical conditions that require investigation or treatment.

Growth concerns may include short stature, slow growth, delayed growth, or poor growth following a normal start in life. Less commonly, growth problems may be related to hormonal conditions such as growth hormone deficiency, thyroid disorders or other medical conditions affecting nutrition, the digestive system or overall health.

At our clinic, we carefully assess every child individually to determine whether their growth pattern is a normal variation or whether further investigation is needed.

What are the signs that my child's growth should be assessed?

Children grow at different rates, but you may wish to seek specialist advice if your child:

  • Is significantly shorter than other children of the same age
  • Has dropped down centiles on their growth chart
  • Has grown very little over six to twelve months
  • Was born small and has not caught up in growth by around two years of age
  • Has delayed puberty alongside poor growth
  • Has a chronic medical condition affecting growth
  • Has a family history of endocrine or genetic conditions affecting height

Parents often notice that clothes and shoes are lasting much longer than expected or that siblings seem to have grown much faster at the same age.

When should I seek medical advice?

Most children who are shorter than average are healthy and simply follow their family's natural growth pattern. However, an assessment is recommended if your child's growth appears to be slowing, if they are significantly shorter than expected for their family, or if you have concerns about their development.

You should seek medical advice if:

  • Your child's height is well below the expected range for their age
  • Growth has slowed noticeably over time
  • Puberty appears delayed alongside poor growth
  • Your child has persistent tiredness, weight changes or other symptoms that could suggest a hormonal condition
  • Your child was born small for gestational age and has not experienced expected catch-up growth

Early assessment can help identify any underlying problems and, where appropriate, allow treatment to begin at the most effective time.

What causes poor growth?

There are many possible reasons why a child may grow more slowly than expected. In many cases, there is no underlying illness and the child is simply following their natural growth pattern.

Possible causes include:

  • Familial (genetic) short stature
  • Constitutional delay of growth and puberty ("late bloomers")
  • Growth hormone deficiency
  • Thyroid disorders
  • Children born small for gestational age (SGA) who have not achieved catch-up growth
  • Coeliac disease
  • Chronic kidney, heart or gastrointestinal conditions
  • Nutritional deficiencies
  • Certain genetic conditions

Our role is to identify whether your child's growth is a normal variation or whether further investigation is required.

How are growth concerns investigated?

Your child's consultation will begin with a detailed discussion about their medical history, growth pattern and family history. We will carefully measure your child's height and weight and compare these with standard growth charts.

Depending on the findings, further investigations may include:

  • Blood tests to assess hormone levels and general health
  • Thyroid function tests
  • Screening for coeliac disease
  • Bone age X-ray of the hand and wrist
  • Growth hormone testing (if appropriate)
  • Genetic testing in selected cases
  • Imaging studies where clinically indicated

Not every child will require all of these investigations. Testing is tailored to each child's individual circumstances.

What treatment is available?

Treatment depends on the underlying cause of your child's growth concerns.

Many children simply require monitoring over time with regular measurements to ensure they continue following a healthy growth pattern.

Where an underlying condition is identified, treatment may include:

  • Growth hormone therapy for eligible children with growth hormone deficiency and certain other recognised conditions
  • Treatment of thyroid disorders
  • Nutritional advice and support
  • Management of underlying medical conditions affecting growth
  • Ongoing monitoring of growth and puberty

Your paediatric endocrinologist will explain the diagnosis, discuss any treatment options and develop a personalised care plan for your child.

Long-term outlook

The outlook depends on the underlying cause of your child's growth concerns.

Many children who are naturally shorter than average remain healthy and reach an adult height that is appropriate for their family. Where a medical cause is identified, early diagnosis and treatment can often improve growth and optimise adult height.

Regular follow-up allows your child's progress to be monitored and treatment adjusted as they grow.