Constitutional growth delay refers to children who are small for their age but are growing at a normal rate. Puberty is often late in these children.
These children continue to grow after most of their peers have stopped. Most of the time, they will reach an adult height similar to their parents' height. However, other causes of growth delay must be ruled out.
Genetics may also play a role. One or both parents may be short. Short but healthy parents may have a healthy child who is in the shortest 5% for his or her age. These children are short, but they should reach the height of one or both of their parents.
Delayed or slower-than-expected growth can be caused by many different things, including:
Many children with delayed growth also have delays in development.
If slow weight gain is due to a lack of calories, try feeding the child on demand. Increase the amount of food offered to the child. Offer nutritional, high-calorie foods.
It is very important to prepare formula exactly according to directions. Do not water down (dilute) ready-to-feed formula.
Call your health care provider if
Contact your health care provider if you are concerned about your child’s growth. Medical evaluations are important even if you think developmental delays or emotional issues may be contributing to a child's delayed growth.
If your child is not growing due to a lack of calories, your health care provider can refer you to a nutrition expert who can help you choose the right foods to offer your child.
What to expect at your health care provider's office
The health care provider will examine the child and measure height, weight, and head circumference. The parent or caregiver will be asked questions about the child's medical history, including:
Has the child always been on the low end of the growth charts?
Did the child's growth start out normal and then slow down?
Is the child developing normal social skills and physical skills?
Does the child eat well? What kinds of foods does the child eat?
What type of feeding schedule is used?
Is the infant fed by breast or bottle?
If the baby is breast fed, what medications does the mother take?
If bottle-fed, what kind of formula is used? How is the formula mixed?
What medications or supplements does the child take?
How tall are the child's biological parents? How much do they weigh?
What other symptoms are present?
The health care provider may also ask questions about parenting habits and the child's social interactions.
Stool studies (to check for poor nutrient absorption)
X-rays to determine bone age and to look for fractures
Cooke DW, Divall SA, Radovick S. Normal and aberrant growth. In: Kronenberg HM, Melmed S, Polonsky KS, Larsen PR, eds. Williams Textbook of Endocrinology. 12th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 24.
McLean HS, Price DT. Failure to thrive. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier;2011:chap 38.
Jennifer K. Mannheim, ARNP, Medical Staff, Department of Psychiatry and Behavioral Health, Seattle Children's Hospital. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, David R. Eltz, Stephanie Slon, and Nissi Wang.