Constitutional Growth Delay (CDG): Causes, Symptoms, Diagnosis, and Treatment

Medically Reviewed by Dr. Devin Stone ND on 05/30/2026

Is your child shorter than their classmates but otherwise healthy?
If so, they may have Constitutional Growth Delay (CDG), one of the most common causes of short stature in children and adolescents.

Children with constitutional growth delay are often referred to as “late bloomers.” They typically grow at a normal rate but experience a delayed growth spurt and delayed puberty compared to their peers. In most cases, these children eventually reach a normal adult height consistent with their genetic potential.

At HGHforChildren.com, we help families understand whether a child's delayed growth is part of a normal variation in development or whether further evaluation is needed to rule out underlying medical conditions.

What Is Constitutional Growth Delay?

Constitutional Growth Delay (CDG), also called Constitutional Delay of Growth and Puberty (CDGP), is a normal growth pattern characterized by:

  • Short stature during childhood
  • Delayed bone age
  • Delayed puberty
  • Family history of "late bloomers"
  • Eventual catch-up growth

Unlike children with growth hormone deficiency or other medical disorders, children with constitutional growth delay generally have normal health and normal growth potential.

Constitutional Growth Delay vs. Growth Hormone Deficiency

Many parents worry their child may have growth hormone deficiency when they notice delayed growth.

However, constitutional growth delay is different.

Constitutional Growth Delay Growth Hormone Deficiency
Growth pattern delayed but usually normal Growth velocity often significantly impaired
Delayed bone age Delayed bone age common
Puberty delayed Puberty may also be delayed
Often family history of late bloomers May not have family history
Usually reaches normal adult height May not reach genetic height potential without treatment
Growth hormone levels typically normal Growth hormone testing may be abnormal

A thorough evaluation is often necessary to distinguish between the two conditions.

Common Signs of Constitutional Growth Delay

Children with constitutional growth delay may exhibit:

Short Stature

Height is below average compared to peers of the same age.

Delayed Puberty

Pubertal development begins later than expected.

Boys may show:

  • Delayed testicular enlargement
  • Lack of facial hair
  • Delayed voice changes

Girls may show:

  • Delayed breast development
  • Delayed onset of menstruation

Delayed Bone Age

A bone age X-ray often reveals skeletal maturation that is younger than the child's chronological age.

Family History of Late Growth

Many parents report:

  • "I was the shortest kid in class."
  • "I didn't grow until high school."
  • "Puberty started late for me too."

These patterns frequently run in families.

What Causes Constitutional Growth Delay?

The exact cause is not fully understood.

Researchers believe constitutional growth delay is largely genetic and represents a normal variation of growth and development rather than a disease process.

Factors commonly associated with CDG include:

  • Family history of delayed growth
  • Delayed activation of puberty hormones
  • Delayed skeletal maturation
  • Genetic growth patterns

Importantly, constitutional growth delay is considered a diagnosis of exclusion, meaning healthcare providers should first rule out other causes of short stature.

How Is Constitutional Growth Delay Diagnosed?

A pediatric growth evaluation generally includes:

1. Growth Chart Analysis

Your child's:

  • Height percentile
  • Weight percentile
  • Growth velocity
  • Mid-parental target height

are reviewed to identify abnormal growth patterns.

2. Bone Age X-Ray

A left hand and wrist X-ray is commonly used to compare skeletal maturity to chronological age.

Children with constitutional growth delay often have a bone age that is significantly delayed.

3. Laboratory Testing

Testing may include:

  • IGF-1
  • IGFBP-3
  • Thyroid studies
  • CBC
  • Comprehensive metabolic panel
  • Celiac screening

These tests help rule out medical causes of poor growth.

4. Growth Hormone Testing

Some children require growth hormone stimulation testing when growth hormone deficiency remains a concern.

This testing can help distinguish constitutional growth delay from true growth hormone deficiency.

5. Pediatric Endocrinology Evaluation

A pediatric growth specialist can interpret growth patterns and determine whether further testing or treatment is appropriate.

What Is Bone Age and Why Is It Important?

Bone age is one of the most useful tools in evaluating delayed growth.

A delayed bone age suggests that the growth plates may remain open longer than expected, allowing additional time for growth.

For example:

  • Chronological age: 13 years
  • Bone age: 11 years

This indicates the skeleton is maturing more slowly than average and future growth potential may still be substantial.

Will My Child Catch Up in Height?

In many cases, yes.

Children with constitutional growth delay often:

  • Enter puberty later
  • Experience a later growth spurt
  • Continue growing after peers have stopped
  • Reach an adult height within their genetic target range

This is why constitutional growth delay is often referred to as a "late bloomer" pattern.

Can Constitutional Growth Delay Affect Emotional Health?

Absolutely.

Children who are significantly shorter than their peers may experience:

  • Reduced self-confidence
  • Social anxiety
  • Teasing or bullying
  • Sports participation challenges
  • Concerns about appearance

While constitutional growth delay is medically benign, the emotional impact can be significant for some children and adolescents.

Treatment Options for Constitutional Growth Delay

Not every child with constitutional growth delay requires treatment.

Management depends on:

  • Growth velocity
  • Bone age
  • Predicted adult height
  • Psychological impact
  • Presence of additional growth disorders

Observation

Many children simply require:

  • Growth monitoring
  • Repeat measurements
  • Periodic bone age assessment

Hormonal Intervention

In select cases, pediatric endocrinologists may consider therapies aimed at supporting growth and pubertal development.

Potential options may include:

  • Growth hormone therapy (when indicated)
  • Short-term puberty induction
  • Other specialist-directed therapies

Treatment decisions should always be individualized and based on a complete endocrine evaluation.

When Should Parents Seek a Growth Evaluation?

Consider a pediatric growth assessment if your child:

  • Is below the 3rd percentile for height
  • Is significantly shorter than expected based on parental heights
  • Is growing less than expected each year
  • Shows delayed puberty
  • Has a delayed bone age
  • Has fallen off their growth curve
  • Has concerns about growth or development

Early evaluation can help identify whether a child is simply a late bloomer or whether a treatable condition is contributing to poor growth.

Frequently Asked Questions

Is constitutional growth delay a disease?

No. Constitutional growth delay is generally considered a normal variation in growth and development rather than a disease.

Is constitutional growth delay genetic?

It often runs in families and is frequently associated with a history of delayed growth or delayed puberty in parents or siblings.

Can a child with constitutional growth delay still have growth hormone deficiency?

Yes. Although uncommon, some children with delayed growth may have underlying growth hormone deficiency or another medical condition. A complete evaluation is necessary.

Does delayed bone age mean my child will grow taller?

A delayed bone age often indicates additional growth potential remains, but final height depends on many factors including genetics and overall health.

Why Choose HGHforChildren.com?

At HGHforChildren.com, we specialize in comprehensive pediatric growth evaluations for children with:

  • Constitutional Growth Delay
  • Growth Hormone Deficiency
  • Idiopathic Short Stature
  • Delayed Bone Age
  • Delayed Puberty
  • Poor Growth Velocity
  • Low IGF-1
  • Pituitary Disorders

Our goal is to help parents understand their child's growth potential and identify whether additional testing or treatment may be beneficial.

Medical References

Medically Reviewed By

Dr. Devin Stone, ND
Founder, HGHforChildren.com

Dr. Devin Stone is a naturopathic doctor specializing in pediatric growth evaluation, hormone optimization, and evidence-based growth support. He works with families nationwide to assess short stature, delayed puberty, constitutional growth delay, bone age abnormalities, growth hormone deficiency, and other pediatric growth concerns. His approach combines comprehensive growth analysis, advanced laboratory testing, bone age interpretation, and individualized treatment planning to help children reach their full growth potential.

Last Medically Reviewed: May 2026