My Child Hasn’t Grown in a Year: Should I Be Concerned?

If your child hasn't grown in a year, it is reasonable to take a closer look.

Children do not grow at exactly the same rate every month, and measurements taken at home can sometimes be inaccurate. However, little or no measurable height growth over approximately 12 months—particularly in a school-age child who has not finished puberty—can warrant medical evaluation.[1,2]

For children between approximately age 5 and puberty, typical linear growth is around 5–6 cm (about 2–2.4 inches) per year. Growth accelerates during puberty, although the timing of the pubertal growth spurt varies considerably between children.[1]

The most important question is therefore not simply:

“Is my child short?”

It is:

“Is my child growing at an appropriate rate for their age and stage of development?”

A child can be shorter than average and completely healthy if they continue growing steadily. In contrast, a child who was previously growing normally but has stopped growing, has very slow growth velocity, or is falling across height percentiles deserves closer attention.[1,2]

Key Takeaways

• Little or no height growth for a full year can be a reason to evaluate a child more closely.
• School-age children before puberty commonly grow around 2 inches per year.[1]
• Growth velocity is often more informative than height percentile alone.
• Falling across growth percentiles can be more concerning than simply being short.[2]
• Genetics and constitutional growth delay are common explanations for shorter stature.
• Nutrition, thyroid disease, celiac disease, chronic illness, delayed puberty, and growth hormone deficiency can also affect growth.[2]
• A bone age X-ray can provide information about skeletal maturity and remaining growth potential.
• Low IGF-1 alone does not diagnose growth hormone deficiency.
• Growth hormone stimulation testing is not the first test every short child needs.
• Earlier evaluation can be useful because height growth is only possible while growth plates remain active.

How Much Should a Child Grow in One Year?

Normal growth depends heavily on age.

Children grow extremely rapidly during infancy, slower during childhood, and then accelerate again during puberty.

Approximate growth velocities include:[1]

Age/Development Stage	Approximate Growth Per Year
Birth to 12 months	9–11 inches
Second year	About 4–5.5 inches
Ages 2–3	About 3 inches
Ages 3–5	About 2.5–3 inches
Age 5 to puberty	About 2–2.4 inches
Pubertal growth spurt — girls	About 3–4.7 inches
Pubertal growth spurt — boys	About 4–5.5 inches

These are population averages rather than strict requirements for every child.

The Pediatric Endocrine Society emphasizes that a child's rate of growth, or growth velocity, is an important part of determining whether a growth pattern is normal.[2]

Is It Normal for a Child Not to Grow for a Year?

For a school-age child who has not completed puberty, truly having no linear growth over an entire year is not the expected pattern.

However, before assuming that growth has stopped, make sure the measurements are accurate.

Children can appear not to have grown because of:

• Different measuring techniques
• Measuring with shoes on during one measurement
• Different equipment
• Poor posture
• Measuring at different times of day
• Rounding measurements
• Recording errors

Children also grow in spurts rather than gaining the exact same amount of height each month.

For this reason, clinicians generally use accurate serial measurements rather than comparing isolated numbers. Measurements at least several months apart—and preferably over 6–12 months—provide a better estimate of true growth velocity.[1]

What Is Growth Velocity?

Growth velocity means how quickly a child gains height over time.

The calculation is simple:

Current height − previous height = height gained

Then adjust that amount to a yearly rate if the measurements are less than 12 months apart.

For example:

A child was 50 inches tall last year and is 52 inches tall today.

Their approximate growth velocity is:

2 inches per year.

Growth velocity is one of the most important measurements in pediatric growth assessment.

Why Growth Velocity Matters More Than Height Alone

Consider two children.

Child A

• Height: 5th percentile
• Has remained around the 5th percentile for several years
• Growing steadily

Child B

• Previously: 50th percentile
• Then: 30th percentile
• Then: 15th percentile
• Growth has slowed substantially

Child A may simply be naturally shorter.

Child B may deserve more investigation even though Child B is technically taller.

The Pediatric Endocrine Society notes that crossing downward through height percentile lines can be a warning sign of an underlying problem affecting growth.[2]

That is why doctors evaluate the trajectory, not just today's percentile.

My Child Is Not Growing in Height: What Could Cause It?

There are many reasons a child may experience slow growth or no apparent height gain.

Some represent normal developmental variation.

Others can indicate a medical, nutritional, endocrine, or genetic condition.

Common possibilities include:

1. Familial short stature
2. Constitutional growth delay
3. Delayed puberty
4. Inadequate nutrition
5. Celiac disease or gastrointestinal disease
6. Hypothyroidism
7. Growth hormone deficiency
8. Chronic medical conditions
9. Certain medications
10. Genetic conditions

The growth pattern often provides clues about which explanation is more likely.

1. Familial Short Stature

Some children are naturally shorter because their parents are shorter.

This is called familial short stature.

These children are often:

• Shorter than average
• Growing at a relatively normal rate
• Following a consistent height percentile
• Developing at an expected age
• Tracking reasonably close to their genetic height potential

Being short and not growing appropriately are therefore not the same thing.

A naturally short child should still gain height over time.

2. Constitutional Growth Delay: The “Late Bloomer”

Some children are healthy but develop later than their peers.

This is known as constitutional growth delay.

These children may:

• Look younger than classmates
• Enter puberty later
• Have a delayed bone age
• Experience their growth spurt later
• Continue growing after peers have slowed

The Pediatric Endocrine Society identifies constitutional delay of growth and puberty as a common normal explanation for short stature.[2]

A family history of being a “late bloomer” can also provide an important clue.

3. Delayed Puberty

Puberty dramatically affects growth velocity.

Before puberty, children typically grow steadily.

During puberty, growth accelerates.

If puberty is delayed, the expected adolescent growth spurt may also occur later.

A child may therefore appear significantly shorter than classmates who have already entered puberty.

However, delayed puberty should be distinguished from a child whose overall growth velocity is abnormal.

Puberty timing, growth velocity, and bone age can help clarify the difference.

4. Nutrition and Not Eating Enough

Children need adequate calories and nutrients to support normal growth.

Poor growth may occur with:

• Inadequate calorie intake
• Restrictive eating
• Very selective eating
• Low protein intake
• Malnutrition
• Vitamin or mineral deficiencies
• Eating disorders
• Gastrointestinal conditions that interfere with absorption

Weight history can provide useful clues.

When poor nutrition or systemic disease causes growth problems, weight gain may also be affected.

5. Celiac Disease and Digestive Disorders

Some gastrointestinal diseases can interfere with growth.

Examples include:

• Celiac disease
• Inflammatory bowel disease
• Chronic malabsorption
• Other significant gastrointestinal disorders

Importantly, a child does not always need dramatic digestive symptoms for growth to be affected.

In some children, poor growth may be one of the clues that leads to further testing.[2]

6. Thyroid Problems

Thyroid hormone is important for normal childhood growth.

Hypothyroidism, or an underactive thyroid, can reduce growth velocity.

Other possible symptoms can include:

• Fatigue
• Constipation
• Dry skin
• Feeling cold
• Reduced energy
• Changes in weight

Thyroid testing is commonly considered when a child's growth pattern suggests an endocrine cause.

7. Growth Hormone Deficiency

Growth hormone deficiency is one possible endocrine cause of poor linear growth.

Growth hormone is produced by the pituitary gland and helps regulate childhood growth, partly through insulin-like growth factor 1 (IGF-1).

Children with growth hormone deficiency may demonstrate:

• Slow growth velocity
• Progressive decline in height percentile
• Short stature
• Delayed bone age
• Delayed skeletal maturation

However, an important point for parents is:

Most children who are short do not have growth hormone deficiency.[2]

Growth hormone deficiency requires an appropriate clinical evaluation rather than being diagnosed from height alone.

Does Low IGF-1 Mean My Child Has Growth Hormone Deficiency?

No.

Low IGF-1 can be an important clue, but it does not establish a diagnosis by itself.

IGF-1 levels are affected by factors including:

• Age
• Puberty
• Nutrition
• Chronic illness
• Overall health
• Growth hormone signaling

Doctors therefore interpret IGF-1 alongside the child's:

• Growth velocity
• Height
• Bone age
• Pubertal stage
• Medical history
• Other laboratory results

If growth hormone deficiency remains a significant concern, additional endocrine testing may be considered.

8. Chronic Medical Conditions

Many chronic diseases can interfere with childhood growth.

The Pediatric Endocrine Society lists conditions affecting major organ systems among the potential medical causes of abnormal growth, including heart, kidney, gastrointestinal, hematologic, and inflammatory disorders.[2]

Growth problems can therefore occasionally be a sign of a health issue that is not primarily an endocrine disorder.

9. Medications That Can Affect Growth

Some medications may affect growth in certain children.

Examples can include:

• Prolonged systemic corticosteroid treatment
• Some medications used for ADHD
• Certain other chronic medications

The effect varies considerably depending on medication, dose, duration, underlying condition, nutrition, and the individual child.[1,2]

Medications should not be stopped solely because of growth concerns without discussing the issue with the prescribing clinician.

10. Genetic Conditions

Some genetic conditions can affect height and growth.

Examples include:

• Turner syndrome
• Noonan syndrome
• SHOX-related disorders
• Down syndrome
• Silver-Russell syndrome
• Other skeletal or genetic conditions

Sometimes physical findings or family history suggest the need for genetic evaluation.

In other cases, poor growth may be one of the first findings that prompts further investigation.

Red Flags: When Should I Be Concerned About My Child's Growth?

Parents should consider discussing growth with a healthcare professional if a child:

• Has shown little or no measurable height growth over approximately one year
• Is growing less than approximately 2 inches per year between age 5 and puberty
• Is falling across height percentiles
• Is below the 3rd percentile for height
• Is significantly shorter than expected from parental heights
• Has delayed puberty
• Has poor weight gain or unexplained weight loss
• Has persistent abdominal pain, diarrhea, or gastrointestinal symptoms
• Has significant fatigue
• Has headaches or vision symptoms along with abnormal growth
• Has an abnormal bone age
• Has previously abnormal growth-related laboratory testing

A growth velocity below approximately 5 cm (2 inches) per year in a school-age child before puberty is one commonly used reason to consider additional evaluation or referral.[1]

Falling Off the Growth Chart: What Does It Mean?

Parents frequently hear the phrase:

“Your child is falling off the growth curve.”

This usually means the child's height has crossed downward through percentile lines over time.

For example:

50th percentile → 35th → 20th → 10th

That pattern can be more significant than simply being consistently near the 5th percentile.

CDC growth charts are designed to help clinicians track stature-for-age over time, but the CDC emphasizes that growth charts are not diagnostic by themselves. They contribute to the child's overall clinical assessment.

How Doctors Evaluate a Child Who Hasn't Grown

A proper growth evaluation usually starts with the basics rather than immediately ordering advanced hormone tests.

1. Confirm Accurate Height

Accurate measurement is essential.

Children older than approximately 2 years should generally be measured standing using appropriate height-measurement equipment.

Small measurement errors can create the appearance of abnormal growth.

2. Review the Entire Growth Chart

The clinician looks at previous heights rather than only today's measurement.

CDC recommends using CDC growth charts for children and adolescents age 2 years and older in the United States, while WHO standards are recommended from birth through age 2.

Questions include:

• Has the child always been short?
• When did growth begin slowing?
• Has the child crossed percentiles?
• Did weight change before height?
• Is the child approaching puberty?

3. Calculate Growth Velocity

This is one of the most important steps.

Accurate measurements over 6–12 months can help determine whether growth is truly abnormal.[1]

The Pediatric Endocrine Society notes that monitoring growth over time is often the most useful initial “test” for a child's growth pattern.[2]

4. Compare Height With Family Genetics

Parental heights provide context for a child's expected adult height.

Clinicians may calculate mid-parental height to estimate a genetic target range.

A shorter child with shorter parents may be following an appropriate family pattern.

A child whose predicted adult height is substantially below their genetic expectation may deserve additional evaluation.

5. Assess Puberty

Puberty stage is essential when interpreting growth.

A 13-year-old who has not entered puberty should not necessarily be expected to grow at the same rate as a 13-year-old who is in the middle of a pubertal growth spurt.

This is particularly important when distinguishing:

• Normal late development
• Constitutional growth delay
• Delayed puberty
• Abnormal growth

6. Consider a Bone Age X-Ray

A bone age X-ray usually uses an image of the left hand and wrist to estimate skeletal maturity.

It can help answer questions such as:

• Is skeletal development delayed?
• Is skeletal development advanced?
• Does the child potentially have additional growth time?
• Is puberty progressing as expected?
• How does skeletal age compare with chronological age?

Bone age is routinely used as one component of short-stature evaluation.[1]

What Does Delayed Bone Age Mean?

A delayed bone age means the skeleton appears younger than expected based on chronological age.

For example:

Chronological age: 14

Bone age: 12

This can occur in children with constitutional growth delay, but it can also occur with endocrine disorders and certain chronic health conditions.

A delayed bone age may indicate that more growth time remains, but it does not guarantee a specific final height.

7. Blood Testing When Appropriate

Not every shorter child requires extensive laboratory testing.

If growth velocity is normal and the child appears healthy, testing may be limited.

When growth is abnormal, testing may include:

• Complete blood count
• Comprehensive metabolic panel
• Thyroid-stimulating hormone
• Free T4
• IGF-1
• IGFBP-3
• Celiac screening
• Inflammatory markers
• Other testing based on symptoms and history

The Pediatric Endocrine Society notes that children below approximately the third percentile or growing more slowly than normal are more likely to undergo laboratory evaluation for potential causes.[2]

Does My Child Need a Growth Hormone Stimulation Test?

Not necessarily.

Growth hormone is released in pulses, so a random growth hormone level is generally not useful for diagnosing growth hormone deficiency.

When a child's:

• Growth pattern is abnormal
• Growth velocity is low
• Clinical findings raise concern
• IGF-1/IGFBP-3 results support further investigation

a pediatric endocrine evaluation may lead to growth hormone stimulation testing.

The decision should be based on the entire clinical picture rather than height alone.

Does My Child Need an MRI?

Most children with slow growth do not automatically need an MRI.

Pituitary imaging may be considered in selected children when evaluation suggests a pituitary or central nervous system disorder, particularly after growth hormone deficiency or other pituitary abnormalities have been identified or strongly suspected.

What If My Child Is Short but Growing Normally?

This is an important distinction.

A child can be short and healthy.

Common explanations include:

Familial Short Stature

The child is genetically shorter but grows at a normal rate.

Constitutional Growth Delay

The child develops later but continues growing appropriately for their delayed developmental timeline.

Idiopathic Short Stature

The child is significantly shorter than average without an identifiable disease explaining the height.

These children have different growth patterns and may require different approaches.

What If My Child Suddenly Stopped Growing?

A change from previous growth deserves particular attention.

If a child previously grew normally and then experiences significant growth deceleration, clinicians may look for changes involving:

• Nutrition
• Weight
• Gastrointestinal health
• Thyroid function
• Chronic illness
• Medications
• Puberty
• Growth hormone axis
• Psychosocial or environmental factors

A sudden change in trajectory can sometimes be more informative than the child's absolute height.

My Child Hasn't Grown but Is Gaining Weight

This pattern can provide useful diagnostic information.

Some endocrine conditions can cause slowing of height growth while weight is maintained or increases.

By contrast, nutritional problems and many systemic diseases may affect weight before or along with height.

This is not diagnostic by itself, but the relationship between height and weight can help guide the evaluation.[1]

My Child Hasn't Grown and Isn't Gaining Weight

When both height and weight are affected, clinicians may consider:

• Inadequate calorie intake
• Malabsorption
• Celiac disease
• Inflammatory bowel disease
• Chronic illness
• Significant nutritional problems

The child's entire medical and dietary history becomes important.

Can Poor Sleep Affect a Child's Growth?

Normal growth hormone secretion occurs in pulses, with important secretion occurring during sleep.

Healthy sleep is therefore part of normal childhood development.

Children should be evaluated if there are concerns about:

• Chronic sleep deprivation
• Severe snoring
• Sleep apnea
• Frequent nighttime waking
• Other significant sleep disorders

However, simply sleeping extra hours does not make a healthy child grow beyond their genetic potential.

Can Nutrition Help a Child Grow Taller?

Good nutrition helps children reach their normal growth potential.

Growing children require adequate:

• Calories
• Protein
• Calcium
• Vitamin D
• Zinc
• Iron
• Other essential nutrients

Correcting a nutritional deficiency may improve growth when inadequate nutrition is contributing.

However, supplements marketed as “height boosters” cannot override genetics or reopen fused growth plates.

Can a Child Catch Up After Not Growing?

Sometimes.

The answer depends on why growth slowed.

A child with constitutional growth delay may experience a later growth spurt.

A child with nutritional deficiency may experience catch-up growth after the underlying problem is corrected.

Children with certain endocrine disorders may improve growth after appropriate treatment.

But catch-up growth cannot be assumed.

The child's:

• Age
• Bone age
• Puberty stage
• Growth plates
• Diagnosis
• Previous growth pattern

all influence how much growth may remain.

Could My Child Need Growth Hormone Treatment?

Possibly—but slow growth alone does not determine whether HGH for children is appropriate.

Recombinant growth hormone is used for specific pediatric indications and selected growth disorders.

Before treatment is considered, clinicians generally need to understand:

• Why the child is growing slowly
• Whether growth plates remain active
• Growth velocity
• Bone age
• Puberty stage
• Laboratory findings
• Diagnosis
• Expected benefit
• Potential risks

Growth hormone deficiency is only one possible explanation for poor growth.

Why Early Evaluation Can Matter

Parents sometimes wait several years because they are told:

“They'll probably catch up.”

In many cases, the child truly is a healthy late bloomer.

But persistent poor growth should still be documented and understood.

Growth potential changes as children progress through puberty.

Once growth plates close, normal long-bone height growth ends.

Early evaluation does not mean a child needs treatment.

It simply provides more time to understand whether the growth pattern is normal or whether something treatable is contributing.

Parent Action Plan: What to Do If Your Child Hasn't Grown in a Year

Step 1: Verify the Measurement

Measure height accurately without shoes.

Whenever possible, compare measurements obtained using similar equipment.

Step 2: Find Previous Heights

Collect measurements from:

• Pediatrician visits
• School physicals
• Sports physicals
• Previous medical records

Step 3: Calculate Growth Velocity

Determine exactly how many inches or centimeters your child has grown over the last 6–12 months.

Step 4: Review the Growth Chart

Look for downward movement across percentiles rather than focusing only on today's height.

Step 5: Consider Family Height

Compare your child's trajectory with parental height and family puberty patterns.

Step 6: Review Puberty

Determine whether puberty appears early, average, or delayed.

Step 7: Consider Bone Age

When clinically appropriate, bone age can provide valuable information about skeletal maturity and remaining growth potential.

Step 8: Seek Evaluation if Growth Is Persistently Slow

If a school-age child has truly experienced little or no growth over a year, discussing the pattern with a qualified healthcare professional is reasonable.

The Bottom Line: Should You Be Concerned If Your Child Hasn't Grown in a Year?

If your child hasn't grown in a year, don't judge the situation from one measurement alone—but don't ignore a persistent lack of height gain either.

For most school-age children who have not reached puberty, ongoing linear growth is expected. A growth velocity of approximately 2 inches per year is common between age 5 and puberty, with faster growth expected during the pubertal growth spurt.[1]

The most important factors are:

• Growth velocity
• Height percentile
• Changes in the growth curve
• Family height
• Puberty timing
• Bone age
• Nutrition
• Overall health
• Hormone function

A short child who continues growing steadily may be perfectly healthy.

A child who stops growing or progressively falls through height percentiles deserves a closer look.

The goal of evaluation is not to assume that something is wrong or that treatment is necessary.

It is to answer a much more useful question:

“Why has my child's growth slowed, and does their growth pattern require further evaluation?”

Concerned That Your Child Has Stopped Growing?

If your child has experienced little or no measurable height growth over the past year, has fallen on the growth chart, appears significantly shorter than expected, or has not experienced an expected pubertal growth spurt, a pediatric growth evaluation can help clarify what is happening.

At HGH for Children, a growth evaluation may review:

• Height history
• Growth velocity
• Growth percentiles
• Family height
• Puberty timing
• Bone age
• Growth plate maturity
• IGF-1
• Growth hormone deficiency
• Predicted adult height
• Remaining growth potential

The purpose is to distinguish a healthy shorter child or late bloomer from a child whose growth pattern may warrant additional investigation.

Medically Reviewed By

Dr. Devin Stone, ND

Dr. Devin Stone, ND is a licensed naturopathic doctor and founder of HGHforChildren.com. His clinical focus includes pediatric growth evaluation, short stature assessment, poor growth velocity, delayed puberty, bone age analysis, growth hormone deficiency screening, IGF-1 interpretation, and individualized growth planning for children and adolescents.

Through HGHforChildren.com, Dr. Stone educates families about childhood growth patterns, growth charts, height prediction, growth velocity, skeletal maturity, growth hormone evaluation, and treatment options when medically appropriate.

Medical References

1. Barstow C, Rerucha C. Evaluation of Short and Tall Stature in Children. American Family Physician. 2015;92(1):43–50. Reviews normal growth velocity, accurate serial measurements, mid-parental height, bone age, causes of short stature, and indications for endocrine referral.

2. Pediatric Endocrine Society / American Academy of Pediatrics Section on Endocrinology. Short Stature: A Guide for Families. Reviews growth velocity, growth charts, familial short stature, constitutional growth delay, endocrine causes of poor growth, bone age, and evaluation of children growing more slowly than expected.

3. Centers for Disease Control and Prevention. CDC Growth Charts. CDC recommends WHO growth standards from birth through age 2 and CDC growth charts for children and adolescents age 2 and older in the United States.

4. Caro R, Savel P, Moss PI. Evaluation of Short and Tall Stature in Children. American Family Physician. 2025;111(6). Reviews current evaluation of abnormal childhood growth, including nutritional, systemic, endocrine, metabolic, and genetic causes.

5. Collett-Solberg PF, Ambler G, Backeljauw PF, et al. Diagnosis, Genetics, and Therapy of Short Stature in Children: A Growth Hormone Research Society International Perspective. Hormone Research in Paediatrics. 2019;92(1):1–14. Reviews growth assessment, short stature, growth velocity, bone age, endocrine evaluation, and treatment considerations.

6. Grimberg A, DiVall SA, Polychronakos C, et al. Guidelines for Growth Hormone and Insulin-Like Growth Factor-I Treatment in Children and Adolescents: Growth Hormone Deficiency, Idiopathic Short Stature, and Primary IGF-I Deficiency. Hormone Research in Paediatrics. 2016;86(6):361–397. Provides clinical guidance on pediatric growth hormone deficiency, idiopathic short stature, IGF-1 disorders, evaluation, treatment, and monitoring.