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Delayed growth

Growth - slow (child 0 to 5 years); Weight gain - slow (child 0 to 5 years); Slow rate of growth; Retarded growth and development; Growth delay

Delayed growth is poor or abnormally slow height or weight gains in a child younger than age 5. This may just be normal, and the child may outgrow it.

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Considerations

A child should have regular, well-baby check-ups with a health care provider. These checkups are usually scheduled at the following times:

• 2 to 4 weeks
• 2½ years
• Annually thereafter

Related topics include:

• Developmental milestones record - 2 months
• Developmental milestones record - 4 months
• Developmental milestones record - 6 months
• Developmental milestones record - 9 months
• Developmental milestones record - 12 months
• Developmental milestones record - 18 months
• Developmental milestones record - 2 years
• Developmental milestones record - 3 years
• Developmental milestones record - 4 years
• Developmental milestones record - 5 years

Causes

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 their 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:

• Chronic disease
• Endocrine disorders
• Emotional health
• Infection
• Poor nutrition

Many children with delayed growth also have delays in development.

Home Care

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.

When to Contact a Medical Professional

Contact your 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 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 Office Visit

The 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 medicines does the mother take?
• If bottle-fed, what kind of formula is used? How is the formula mixed?
• What medicines 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 provider may also ask questions about parenting habits and the child's social interactions.

Tests may include:

• Blood tests (such as a CBC or blood differential)
• Stool studies (to check for poor nutrient absorption)
• Urine tests
• X-rays to determine bone age and to look for fractures

Related Information

References

Cooke DW, DiVall SA, Radovick S. Normal and aberrant growth in children. In: Melmed S, Auchus RJ, Goldfine AB, Koenig RJ, Rosen CJ, eds. Williams Textbook of Endocrinology. 14th ed. Philadelphia, PA: Elsevier; 2020:chap 25.

Kimmel SR, Ratliff-Schaub K. Growth and development. In: Rakel RE, Rakel DP, eds. Textbook of Family Medicine. 9th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 22.

Lo L, Ballantine A. Malnutrition. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 59.

Review Date: 1/24/2023  

Reviewed By: Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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