Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Normal growth is the result of several factors, such as nutrition, genetics, and hormones. The following are possible causes of growth failure.
Familial short stature: Children with this condition have parents with short stature. They have a normal growth velocity, and bone age is not delayed. They enter puberty at a normal time and often complete growth with a short adult height.
Constitutional growth delay: Also called delayed puberty, children with constitutional growth delay have a normal birth weight, and their growth slows usually during the first year of life. From about age 3 to puberty, these children have an adequate growth velocity. Bone age is usually delayed, and puberty is late. Late puberty allows for more prepubertal growth, usually resulting in a normal adult height. Usually, children with constitutional growth delay do not show growth failure but a period of slow growth velocity occurs during the first year of life and just before puberty.
Malnutrition: Worldwide, malnutrition is probably the most common cause of growth failure and is usually poverty-related. Nutritional deficiencies in developed countries are more often the result of self-restricted diets. Poor weight gain is often more noticeable than short stature.
Endocrine (hormonal): Endocrine causes include thyroid hormone deficiency (hypothyroidism), growth hormone deficiency, or other hormone disorders. Thyroid hormone is necessary for normal growth; in children with hypothyroidism, growth is extremely slow. Children with growth hormone deficiency have normal body proportions, but they may appear younger than their actual age.
Other: Growth failure may be related to intrauterine growth retardation
(a condition in which children weigh less than 5 pounds at full term or who are small for gestational age if born preterm). Bone and cartilage disorders (called chondrodystrophies) may also be a cause of growth failure. Achondroplasia (one of the most common conditions that cause growth failure and short stature) is a genetic disorder of bone and cartilage. People with achondroplasia have a normal-sized trunk, short arms and short legs, and a slightly enlarged head with a prominent forehead. Adults with this condition are typically about 4 feet tall. There are other chondrodystrophies, such as hypochondroplasia, which are similar to achondroplasia but not as severe.
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Short stature may be the normal expression of genetic potential, in which case the growth rate is normal, or it may be the result of a condition that causes growth failure with a lower-than-normal growth rate.