Pediatrician Says to Wait: When to Seek a Growth Second Opinion

If you're worried that your child isn't growing and your pediatrician has said “let's wait and see,” that advice is not necessarily wrong.

Many shorter children are completely healthy. Some have shorter parents. Others are late bloomers who enter puberty later and continue growing after many of their classmates.

But there are also situations where persistent slow growth, falling height percentiles, delayed puberty, or little measurable height gain deserve further evaluation rather than indefinite observation.[1,2]

So how do you know when waiting is reasonable—and when it may be time to seek a second opinion about your child's growth?

The answer usually comes down to the child's growth velocity, growth chart trajectory, family height, puberty stage, bone age, and overall health rather than height alone.

If your child is consistently short but growing normally, monitoring may be appropriate.

If your child is growing substantially slower than expected or progressively falling on the growth chart, obtaining another evaluation can be reasonable.[1,2]

Key Takeaways

• Being short does not automatically mean a child has a growth disorder.
• Monitoring can be appropriate when a child is growing normally and following a consistent percentile.
• Growth velocity is often more important than a single height measurement.
• School-age children before puberty commonly grow approximately 5–6 cm (about 2–2.4 inches) per year.[1]
• Falling downward across height percentiles deserves closer attention.
• Little or no height gain over approximately a year can warrant evaluation.
• A child's height should be compared with their genetic potential, not only population averages.
• Delayed puberty and delayed bone age can occur in healthy late bloomers but can also require evaluation.
• Low IGF-1 alone does not diagnose growth hormone deficiency.
• Seeking a second opinion does not mean your child needs growth hormone treatment. The goal is to understand why the growth pattern looks the way it does.

When Is “Wait and See” Appropriate for a Short Child?

There are many situations where monitoring growth is medically reasonable.

A child may simply have:

• Familial short stature
• Constitutional growth delay
• Later puberty than peers
• A naturally lower height percentile

If the child is otherwise healthy and maintaining an appropriate growth velocity, observation may be appropriate.[1,2]

For example:

Child A

Age: 9
Height: 5th percentile
Previous height: 5th percentile
Growth velocity: approximately 2 inches per year
Parents: both shorter than average

This child may simply be following their genetically expected growth pattern.

Being at the 5th percentile does not automatically mean something is wrong.

The important question is whether the child continues growing appropriately over time.

When Should You Question the “Wait and See” Approach?

Monitoring becomes less reassuring when the child's growth pattern itself is abnormal.

Consider seeking additional evaluation if your child:

• Has barely grown over 6–12 months
• Has poor growth velocity
• Is progressively falling across height percentiles
• Is substantially shorter than expected based on parental height
• Has delayed puberty
• Has significantly delayed bone age
• Has poor weight gain or unexplained weight loss
• Has chronic gastrointestinal symptoms
• Has fatigue or other systemic symptoms
• Has abnormal thyroid or growth-related laboratory results
• Has a significant discrepancy between chronological age and skeletal development

These findings do not prove that a growth disorder exists.

They indicate that asking why the child is growing slowly may be more useful than simply asking whether the child is short.

Your Child's Growth Velocity May Be the Most Important Clue

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

Growth velocity describes how much height a child gains over a defined period.

For school-age children between approximately age 5 and puberty, normal growth is commonly around 5–6 centimeters per year, or roughly 2–2.4 inches per year.[1]

Growth accelerates during puberty.

A child who is short but gaining approximately 2 inches per year may have a very different situation from a child who is taller but has gained almost no height during the previous year.

Example: Short but Growing vs. Growth Slowing Down

Consider two 10-year-old children.

Child A

• Height: 5th percentile
• Last year: 5th percentile
• Two years ago: 6th percentile
• Continues gaining height steadily

Child B

• Height: 15th percentile
• Last year: 30th percentile
• Two years ago: 50th percentile
• Growth velocity has slowed

Although Child B is currently taller, the downward growth trajectory may deserve more attention.

This is why a child's growth chart should be interpreted longitudinally rather than judging growth from one appointment.

My Child Hasn't Grown in a Year: Should I Still Wait?

If accurate measurements show that a school-age child who has not completed puberty has experienced little or no height growth over approximately 12 months, further evaluation is reasonable.

Children do not grow the exact same amount every month, so short periods without obvious growth are not necessarily concerning.

Measurements can also be inaccurate.

But persistent lack of linear growth is different.

If this describes your child, read our detailed guide: My Child Hasn't Grown in a Year: Should I Be Concerned?

Falling Off the Growth Chart: Why It Matters

A child's percentile does not need to be average.

Some healthy children remain around the 3rd, 5th, or 10th percentile throughout childhood.

More concerning can be a child who repeatedly crosses percentile lines downward.

For example:

75th percentile → 50th → 25th → 10th

This indicates that the child's growth trajectory has changed.

The Pediatric Endocrine Society identifies decreasing growth velocity and crossing height percentiles downward as reasons that additional evaluation may be appropriate.[2]

What Is Considered Short Stature?

Short stature is generally defined as height more than approximately 2 standard deviations below the population mean, corresponding roughly to below the 2nd–3rd percentile for age and sex.[1,3]

But percentile alone does not tell the entire story.

A child at the 2nd percentile could be healthy.

A child at the 25th percentile could have an abnormal growth pattern if they were previously at the 75th percentile.

The assessment should consider:

• Current height
• Previous heights
• Growth velocity
• Family height
• Puberty
• Bone age
• Overall health

Is My Child Just a Late Bloomer?

Possibly.

One common reason pediatricians recommend waiting is constitutional growth delay.

Children with constitutional growth delay are often called “late bloomers.”

They may:

• Be shorter than peers
• Have delayed puberty
• Have a delayed bone age
• Have family members who developed late
• Experience their major growth spurt later

Many ultimately reach an adult height appropriate for their family.[2]

However, “late bloomer” should ideally describe a recognizable growth pattern rather than simply becoming a default explanation for every child with poor growth.

Familial Short Stature vs. Constitutional Growth Delay

These two normal growth patterns are often confused.

Familial Short Stature

The child is genetically shorter.

Typically:

• One or both parents are shorter
• Growth velocity is relatively normal
• Height follows a lower percentile
• Bone age may be relatively consistent with chronological age
• Puberty often occurs at a typical time

Constitutional Growth Delay

The child develops later.

Typically:

• Puberty occurs later
• Bone age is delayed
• Family history may include late bloomers
• Growth spurt occurs later
• Additional growth may continue after peers slow down

Understanding which pattern better describes a child can help determine whether monitoring alone makes sense.

What Is Mid-Parental Height?

A child's expected height should be considered in the context of family genetics.

Clinicians often use mid-parental height to estimate a child's genetic target height.

For boys, an approximate calculation is:

Mother's height + 5 inches + father's height, divided by 2

For girls:

Father's height − 5 inches + mother's height, divided by 2

This produces an estimate rather than a guarantee.

A child significantly shorter than expected based on parental height may deserve additional investigation even if their height is not extremely low compared with the general population.[1]

Bone Age Can Help Determine Whether Waiting Makes Sense

One of the most useful tools for evaluating a child's growth timeline is a bone age X-ray.

Bone age estimates skeletal maturity.

Chronological age tells you how long the child has been alive.

Bone age helps estimate how far the skeleton has progressed through development.

For example:

Chronological age: 14 years

Bone age: 12 years

This suggests skeletal maturation is delayed.

Depending on the rest of the child's evaluation, delayed skeletal maturity may indicate that more growth time remains.

What Does Delayed Bone Age Mean?

A delayed bone age can occur in children with constitutional growth delay.

But delayed bone age can also be associated with conditions including:

• Growth hormone deficiency
• Hypothyroidism
• Nutritional problems
• Certain chronic diseases
• Delayed puberty

Therefore:

Delayed bone age does not automatically mean “everything is fine because your child is a late bloomer.”

It also does not automatically indicate disease.

The finding needs to be interpreted alongside growth velocity, puberty, laboratory results, family history, and the child's overall health.[3]

What If Bone Age Is Not Delayed?

This can also be useful information.

Suppose a teenager is significantly shorter than expected and has a bone age close to chronological age.

That may suggest a different growth timeline from a child of the same chronological age whose skeleton is two years delayed.

As skeletal maturation progresses and growth plates approach fusion, the remaining window for additional height becomes smaller.

Bone age therefore helps put the phrase “they still have plenty of time to grow” into a more objective developmental context.

How Do You Know Whether Growth Plates Are Still Open?

Growth plates are areas of developing cartilage that allow long bones to lengthen.

As puberty progresses, growth plates mature and eventually fuse.

Once complete fusion has occurred, additional normal long-bone height growth is no longer possible.

A hand and wrist bone-age study can provide information about skeletal maturity and growth plate development.

Parents can learn more here: How Do You Know If Your Growth Plates Have Closed?

Delayed Puberty and Slow Growth

Puberty has a major effect on height.

Children grow steadily before puberty and then experience an adolescent growth spurt.

A child who enters puberty later may therefore look much shorter than classmates who have already experienced their growth spurts.

Signs that puberty may be delayed can warrant evaluation.

The Pediatric Endocrine Society generally describes delayed puberty as absence of breast development by age 13 in girls or absence of testicular enlargement by age 14 in boys.[4,5]

Delayed puberty does not necessarily indicate disease, but it can help explain why a child has not experienced an expected growth spurt.

Could Thyroid Disease Cause Slow Growth?

Yes.

Thyroid hormone is important for normal skeletal development and linear growth.

Hypothyroidism can reduce growth velocity.

Depending on the child, other symptoms may include:

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

Thyroid testing is often considered when the growth pattern suggests a possible endocrine cause.

Could Celiac Disease Cause Poor Growth?

Yes.

Celiac disease can interfere with nutrient absorption and childhood growth.

Some children have obvious gastrointestinal symptoms.

Others may present primarily with:

• Poor growth
• Short stature
• Poor weight gain
• Iron deficiency
• Fatigue

This is one reason a growth evaluation may look beyond growth hormone and include broader medical causes.

Could Nutrition Be Affecting My Child's Height?

Adequate nutrition is necessary for normal childhood growth.

Poor growth can occur with:

• Inadequate calories
• Insufficient protein
• Restrictive diets
• Malabsorption
• Chronic gastrointestinal disease
• Significant nutrient deficiencies

Reviewing weight alongside height can provide useful clues.

When weight and height are both affected, nutritional or systemic causes may become particularly important to consider.

Could It Be Growth Hormone Deficiency?

Growth hormone deficiency is one potential cause of abnormal linear growth, but it is much less common than normal variants of short stature.[2]

Children with growth hormone deficiency may have:

• Reduced growth velocity
• Progressive decline in height percentile
• Short stature
• Delayed skeletal maturation
• Low IGF-1 in some cases

Growth hormone deficiency cannot be diagnosed simply because a child is short.

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

No.

IGF-1 is frequently included in the evaluation of abnormal growth because growth hormone stimulates IGF-1 production.

But IGF-1 can also be influenced by:

• Age
• Puberty
• Nutrition
• Chronic illness
• Liver function
• Other physiological factors

A low IGF-1 result therefore needs to be interpreted within the child's complete clinical picture.[3,6]

It should not be used by itself to diagnose growth hormone deficiency.

What Testing May Be Considered for Slow Growth?

The appropriate workup depends on the individual child.

A clinician may begin with:

• Accurate height and weight
• Previous growth records
• Growth velocity
• Family heights
• Pubertal history
• Physical examination

Depending on the findings, laboratory testing may include:

• Complete blood count
• Comprehensive metabolic panel
• TSH
• Free T4
• Celiac screening
• IGF-1
• IGFBP-3
• Inflammatory markers
• Other condition-specific testing

A bone age study may also be useful.

Not every short child needs every test.

Does My Child Need Growth Hormone Stimulation Testing?

Not automatically.

Growth hormone is secreted in pulses, making a single random growth hormone measurement generally unsuitable for diagnosing growth hormone deficiency.

When clinical findings raise sufficient concern for growth hormone deficiency, a pediatric endocrinologist may consider growth hormone stimulation testing.

That decision generally comes after reviewing:

• Growth velocity
• Height pattern
• Bone age
• IGF-1/IGFBP-3
• Medical history
• Puberty
• Other possible explanations for slow growth

When Should a Child See a Pediatric Endocrinologist?

Referral to pediatric endocrinology may be considered when there is:[1,2]

• Significant short stature
• Persistent abnormal growth velocity
• Downward crossing of height percentiles
• Height substantially below genetic expectations
• Delayed puberty
• Abnormal skeletal maturation
• Suspected endocrine disease
• Findings concerning for growth hormone deficiency

A pediatric endocrinologist specializes in hormonal and growth-related disorders in children.

When Should You Seek a Second Opinion About Your Child's Growth?

A second opinion can be particularly reasonable when there is an unexplained discrepancy between reassurance and objective growth data.

Examples include:

1. Your Child Has Barely Grown in a Year

If accurate measurements confirm little or no linear growth, asking for further evaluation is reasonable.

2. Your Child Keeps Falling Across Percentiles

Progressive downward movement deserves an explanation.

3. No One Has Calculated Growth Velocity

“Wait and see” is more meaningful when growth is actually being measured.

4. Your Child Is Much Shorter Than Their Genetic Potential

Family height matters.

5. Puberty Appears Delayed

Delayed puberty can shift the growth timeline and sometimes warrants evaluation.

6. Your Child Has a Significantly Delayed Bone Age

The cause and implications should be interpreted in context.

7. Symptoms Suggest Another Medical Condition

Poor weight gain, gastrointestinal symptoms, fatigue, headaches, vision problems, or other systemic symptoms may change the evaluation.

8. Testing Is Abnormal but Has Not Been Explained

Abnormal thyroid tests, IGF-1, celiac screening, or other findings should be interpreted appropriately rather than considered in isolation.

What Should You Bring to a Growth Second Opinion?

The more growth data available, the more useful the evaluation can be.

Try to bring:

• Previous pediatric records
• Heights from previous years
• Weights from previous years
• Growth charts
• Previous laboratory results
• Bone age report
• Bone age images when available
• Medication list
• Birth history
• Family height information
• Puberty history
• Previous specialist evaluations

A single height measurement tells relatively little.

Several years of measurements can reveal the child's growth trajectory.

Questions to Ask During a Growth Second Opinion

Parents may find it useful to ask:

1. What is my child's current growth velocity?
2. Has my child crossed height percentiles?
3. Is their height appropriate for our family genetics?
4. Is puberty occurring at an expected time?
5. Would bone age provide useful information?
6. Is skeletal maturity delayed or advanced?
7. What conditions could explain this growth pattern?
8. Are laboratory tests appropriate?
9. Should IGF-1 or thyroid function be evaluated?
10. Is pediatric endocrinology referral appropriate?
11. How much growth potential may remain?
12. When should growth be rechecked?

These questions turn “wait and see” into a measurable monitoring plan.

If Your Pediatrician Says to Wait, Ask: “What Are We Waiting For?”

This can be one of the most useful questions a parent asks.

Observation should ideally have measurable goals.

For example:

“Let's remeasure height in six months and calculate growth velocity.”

is different from:

“Don't worry. He'll probably grow eventually.”

A monitoring plan might specify:

• When height will be remeasured
• What growth rate is expected
• What would trigger laboratory testing
• Whether puberty should begin by a particular developmental stage
• When bone age may be appropriate
• When referral would be considered

Waiting becomes much more useful when there is a defined follow-up plan and threshold for further evaluation.

Does Seeking a Second Opinion Mean My Child Needs HGH?

No.

This is an important distinction.

A second opinion is an opportunity to understand the growth pattern.

The conclusion may be:

• Normal familial short stature
• Healthy constitutional growth delay
• Delayed puberty
• Nutritional issue
• Thyroid disorder
• Celiac disease
• Another chronic condition
• Growth hormone deficiency
• Idiopathic short stature
• Another growth disorder

Treatment depends on the diagnosis.

Growth hormone therapy for children is appropriate only in selected clinical circumstances and should not be assumed to be the answer simply because a child is shorter than average.

Why Timing Matters in Pediatric Growth Evaluation

Evaluating slow growth earlier does not mean treatment should automatically begin earlier.

It means understanding the growth pattern while the child is still developing.

Height growth depends on active growth plates.

As puberty advances, skeletal maturation progresses and the growth plates gradually approach fusion.

Once growth plates are completely fused, normal long-bone height growth is no longer possible.

For this reason, identifying an underlying growth problem after skeletal maturity has been reached is very different from identifying it while substantial growth potential remains.

What If the Second Opinion Also Says to Wait?

That can actually be reassuring—particularly if the second evaluation confirms:

• Normal growth velocity
• Stable height percentile
• Height appropriate for family genetics
• Normal health evaluation
• Appropriate puberty
• A growth pattern consistent with constitutional delay

The purpose of a second opinion is not to obtain a different diagnosis.

It is to make sure the current explanation fits the objective growth data.

Sometimes the correct answer really is:

Monitor growth and allow more time.

But ideally, that recommendation is supported by measurable evidence.

The Bottom Line: When “Wait and See” Deserves a Second Look

If your pediatrician says to wait, the most important question is:

What does your child's actual growth data show?

Waiting can be completely appropriate for a healthy child who:

• Is growing at an appropriate rate
• Follows a consistent percentile
• Fits their family's genetic height pattern
• Has an otherwise reassuring evaluation

But a second opinion may be reasonable when a child:

• Has barely grown in 6–12 months
• Has persistently low growth velocity
• Is falling across percentiles
• Is substantially shorter than expected for family genetics
• Has delayed puberty
• Has abnormal bone age
• Has symptoms suggesting an underlying condition

A good growth evaluation should go beyond simply asking:

“How tall is my child?”

It should ask:

How quickly are they growing?

Has their growth pattern changed?

Where are they in puberty?

What is their bone age?

How does their height compare with their genetic potential?

Is there a medical explanation for the change?

The goal of a second opinion is not to find a reason to treat every short child.

It is to make sure that a potentially important change in growth is recognized, appropriately evaluated, and monitored while the child is still growing.

Looking for a Second Opinion About Your Child's Growth?

If your child has been told to wait but continues to grow slowly, has fallen on the growth chart, has delayed puberty, or is significantly shorter than expected, a more detailed growth evaluation may help clarify whether continued monitoring or additional testing is appropriate.

At HGH for Children, an evaluation may review:

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

The purpose of a second opinion is not to assume treatment is necessary. It is to determine whether the recommendation to “wait and see” fits your child's actual growth pattern.

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, skeletal maturity assessment, and individualized growth planning for children and adolescents.

Through HGHforChildren.com, Dr. Stone educates families about childhood growth patterns, growth velocity, growth charts, bone age, puberty, growth plate development, height prediction, 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 pediatric growth velocity, short stature, serial height measurements, mid-parental height, bone age, laboratory evaluation, and referral considerations.

2. Pediatric Endocrine Society. Short Stature: A Guide for Families. Pediatric Endocrine Society. Reviews familial short stature, constitutional growth delay, growth velocity, growth charts, causes of short stature, and evaluation of children growing more slowly than expected.

3. 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. doi:10.1159/000502231. Reviews evaluation of short stature, growth velocity, skeletal maturation, bone age, laboratory evaluation, and growth disorders.

4. Pediatric Endocrine Society. Delayed Puberty in Girls: A Guide for Families. Reviews normal female puberty, delayed breast development, growth, and indications for evaluation.

5. Pediatric Endocrine Society. Delayed Puberty in Boys: A Guide for Families. Reviews normal male puberty, constitutional delay, growth patterns, and evaluation of delayed puberty.

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 Insulin-Like Growth Factor-I Deficiency. Hormone Research in Paediatrics. 2016;86(6):361–397. doi:10.1159/000452150. Reviews pediatric growth hormone deficiency, IGF-1 assessment, idiopathic short stature, treatment selection, and monitoring.