Management of Constitutional Growth Delay

Diagnostic Approach

The American Academy of Pediatrics recommends that growth velocity is the single most common useful indicator, in addition to absolute height, for assessing short stature in children 1
Growth velocity is ideally assessed by reviewing previous growth points or by remeasurement over a 4-6 month interval, according to the American Academy of Pediatrics 1
Short stature is defined as height-for-age less than two standard deviations below average for gender, which is below the 3rd percentile on standard growth curves, as stated by the American Academy of Pediatrics 2

Constitutional growth delay is characterized by deceleration of length/height in the first 3 years of life, with a normal or near-normal height velocity during childhood, as described by the American Academy of Pediatrics 1, 2
Children with constitutional growth delay often have a delayed bone age and pubertal development, and typically reach a final adult height within the normal range, according to the American Academy of Pediatrics 2
A familial pattern of growth and development is often observed in children with constitutional growth delay, as noted by the American Academy of Pediatrics 2

Bone age assessment is crucial to differentiate constitutional growth delay from pathological causes of short stature, as emphasized by the American Academy of Pediatrics 2
A delayed bone age compared to chronological age is characteristic of constitutional growth delay, according to the American Academy of Pediatrics 2
Bone age helps determine remaining growth potential and predict adult height, as stated by the American Academy of Pediatrics 3

The American Academy of Pediatrics suggests that children with constitutional delay of growth typically have an increased remaining growth potential compared to chronological age, allowing for catch-up growth during an extended growth period 4
Basic laboratory workup would be appropriate if growth velocity falls below the 25th percentile for age and sex, as recommended by the Endocrine Society 5, 6

The National Institute of Child Health and Human Development recommends that vitamin D and calcium are important for bone health, but there is no evidence that increasing sunlight exposure or dietary modifications affect the natural course of constitutional delay 7, 8

The American Academy of Pediatrics recommends monitoring growth velocity over 4-6 month intervals to confirm it remains normal, and reassessing if growth velocity declines or other concerning features develop 5

The American Academy of Pediatrics advises that Tanner staging be assessed annually in a 10‑year‑old boy with short stature to track pubertal progression; delayed puberty beyond age 12–13 years should prompt endocrine evaluation. 9  (Strength of evidence: not specified)