Growth failure

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Aditya Govindavarjhulla, M.B.B.S. [2]

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Overview

Growth failure is a medical term for a pattern of a child's growth which is poorer than normal for age, sex, stage of maturation, and genetic height expectation. In general it refers to;

• A slow growth velocity, and
• Stunted growth

Growth failure usually has an abnormal cause or causes. Many short children are growing normally and this is not referred to as growth failure.

Linear growth is measured by change of recumbent length in infants until age 2 to 3 years, when a child's height can be measured standing.

Growth failure is a term used to describe failure to grow in length. Growth is a dynamic process that starts before a child is born and continues until the bones fuse after puberty. After puberty, bones continue to mature to achieve prime bone density.Growth in length per year is age dependent and may be affected by many different factors including, but not limited to; hormonal abnormalities, chronic illness, and genetic abnormalities. Failure to grow should be taken seriously as it may indicate a hidden illness, a pediatrician should be consulted if a child is exhibiting slow growth outside of the ranges shown below. All ranges described are averages for the age range. In addition, to rate of growth,the position of the child on the growth chart (which compares other children of the same age) should be observed.

Doctors and families can follow the progress of the children to make sure that they are achieving their appropriate potential.

Differential Diagnosis

Common Causes

• Achondroplasia
• Crohn's Disease
• Congenital adrenal hyperplasia
• Constitutional delay
• Cushing's Disease
• Cushing's Syndrome
• Cyanotic heart disease
• Cystic Fibrosis
• Dermatomyositis
• Down's Syndrome
• Familial short stature
• Gluten enteropathy
• Growth hormone deficiency
• Growth hormone insensitivity
• Hypochondroplasia
• Hypothyroidism
• Intrauterine growth retardation
• Malnutrition
• Microcephaly
• Noonan Syndrome
• Prader-Willi Syndrome
• Precocious puberty
• Psychosocial dwarfism
• Renal Tubular Acidosis
• Russell-Silver Syndrome
• Turner's Syndrome
• Ulcerative Colitis

Organ system based

Cardiovascular	Atrioventricular septal defect , BlandGarlandWhite syndrome , Congenital heart disease, Cor Triatriatum , Double outlet right ventricle , Endocardial fibroelastosis , Fallot's tetralogy, Patent ductus arteriosus, Transposition of great arteries , Ventricular septal defect
Chemical / poisoning	Lead poisoning
Dermatologic	Leiner Disease
Drug Side Effect	Fetal Hydantoin Syndrome , Fetal thalidomide syndrome , Fetal warfarin syndrome , Prednisolone, Albuterol, Aspirin, Carboplatin, Dexamethasone Acetate, Lasix, Lisinopril, Paxil, Protonix, Revlimid, Tylenol, Zoloft
Ear Nose Throat	No underlying causes
Endocrine	Adiposogenital dystrophy, Adrenal hyperplasia, congenital type 3 , Adrenomyodystrophy , C21 hydroxylase deficiency, Cushing's syndrome , Cystic fibrosis , Diabetes mellitus, Glucocorticoid deficiency, Growth hormone deficiency, Hyperthyroidism, Hypoaldosteronism, Hypopituitarism , Hypothyroidism, KaplowitzBodurtha syndrome , Pseudohypoparathyroidism , Thyroid disease
Environmental	Lead poisoning
Gastroenterologic	Autoimmune enteropathy , Baber's syndrome , Bile acid synthesis defects , Blind loop syndrome , Chronic diarrhoea, Congenital short bowel , Congenital Vitamin B12 Malabsorption , Glucosegalactose malabsorption , Hirschsprung's disease , Malabsorption syndrome, Microvillus Inclusion Disease , Pseudoobstruction idiopathic intestinal
Genetic	14q+ syndrome , 18 Hydroxylase deficiency , 18p minus syndrome , 1q deletion , 2q deletion , 3M syndrome , 3q deletion , 49,XXXXX syndrome , 4p16.3 deletion , Aarskog syndrome , Aase syndrome, Abetalipoproteinaemia, ACAD8 deficiency , Adiposogenital dystrophy, Alagille Syndrome , AlbersSchonberg disease , Albright's hereditary osteodystrophy , AlphaLiduronidase deficiency, Alport Syndrome , Alports syndrome, Alsing syndrome , Aminomethyltransferase deficiency, Andersen disease , Anorexia nervosa, Arginase deficiency , Aspartoacylase deficiency, BardetBiedl syndrome, Barth syndrome , Bloom's syndrome, BonnetDechaumeBlanc syndrome, BowenConradi syndrome , BRESHECK syndrome, Byler Disease , CAH, CAMFAK syndrome , Campomelic dwarfism , Carnitine transporter deficiency , Carnosinase deficiency , Carpenter syndrome , CHARGE syndrome, Chromosome 1 uniparental disomy 1q12 q21 , Chromosome 10 ring syndrome , Chromosome 10, distal trisomy 10q , Chromosome 10p deletion syndrome , Chromosome 11q duplication syndrome , Chromosome 12 ring syndrome , Chromosome 12p deletion , Chromosome 13 ring syndrome , Chromosome 13 trisomy syndrome , Chromosome 14 Ring , Chromosome 14 trisomy , Chromosome 15 trisomy , Chromosome 16p, partial duplication , Chromosome 17 ring , Chromosome 18 Ring , Chromosome 19 ring syndrome , Chromosome 1p deletion syndrome , Chromosome 2 trisomy syndrome , Chromosome 20 ring , Chromosome 20p deletion syndrome , Chromosome 21 monosomy , Chromosome 22, trisomy , Chromosome 2p deletion syndrome , Chromosome 2p duplication syndrome , Chromosome 3, trisomy 3p , Chromosome 3, trisomy 3q , Chromosome 4 Ring , Chromosome 4 ring syndrome , Chromosome 5, trisomy 5q , Chromosome 5p duplication syndrome , Chromosome 5p tetrasomy syndrome , Chromosome 6 ring syndrome , Chromosome 6, monosomy 6q , Chromosome 6, trisomy 6q , Chromosome 7 ring syndrome , Chromosome 8 recombinant syndrome , Chromosome 9 trisomy syndrome , Chromosome 9, trisomy , Classic galactosemia , Cleft palate, Cockayne syndrome, CoffinLowry syndrome, Cohen Syndrome , Complement 5 deficiency, Complete Trisomy 18 syndrome , Complex 5 mitochondrial respiratory chain deficiency , Congenital chloride diarrhea , ConradiHuenermann Syndrome , Corpus callosum agenesis , Criduchat syndrome , De Barsy syndrome, DiamondBlackfan anemia , DiGeorge syndrome , Down syndrome, Edward Syndrome , Faciocardiorenal syndrome, Fallot's tetralogy, Farber's disease , Filippi syndrome, Forbes disease , Francois dyscephalic syndrome , Fucosidosis, Galactosemia , GAPO syndrome , Glucosegalactose malabsorption , HoyeraalHreidarsson syndrome , ICF syndrome , Iduronate sulphatase deficiency, Inborn amino acid metabolism disorder , Inborn urea cycle disorder , Infantile dysphagia , Infantile hypophosphatasia , Infantile Refsum Disease , IPEX syndrome , Ivemark Syndrome , Jeune's thoracic dystrophy syndrome, JirasekZuelzerWilson syndrome , JohansonBlizzard syndrome, JubergMarsidi syndrome , Kabuki makeup syndrome, Kartagener's syndrome, KennyCaffeyLinarelli syndrome, Kowarski syndrome , Leigh syndrome , Leprechaunism, LeriWeill dyschondrosteosis, Lissencephaly , Lowe oculocerebrorenal syndrome , Lowe Syndrome , LutzRichnerLandolt syndrome , Maple syrup urine disease, MardenWalker syndrome, Martsolf syndrome, Menkes Disease , Miescher's syndrome , Mitochondrial diseases, MULIBREY Nanism , Multiple lentigines syndrome, Navajo neurohepatopathy , Neuronal Migration Disorders , Nezelof Syndrome , NiemannPick disease , NOMID syndrome , Omenn syndrome , Opitz trigonocephaly syndrome, Osteogenesis imperfecta, Otopalatodigital syndrome, Pearson's anemia , PelizaeusMerzbacher disease, Phenylketonuria , Pierre Robin's sequence , PittRogersDanks syndrome, Pompe disease , PowellBuistStenzel syndrome , PraderWilli syndrome , Progeroid syndrome, Progressive familial intrahepatic cholestasis, RussellSilver dwarfism, SaethreChotzen Syndrome , SCID , Seckle syndrome , Sheffield syndrome , ShwachmanDiamond Syndrome , Sickle Cell Anemia , Silver's syndrome, SingletonMerten Syndrome , TaySachs disease, Thyroid agenesis , Transposition of great arteries , Trisomy 18 Syndrome , Turner syndrome , Tyrosinemia , VATER association , Velocardiofacial syndrome, Von Gierke disease , WAGR Syndrome , Watson syndrome , Williams syndrome, Wittwer sydnrome , WolcottRallison syndrome , YunisVaron syndrome, ZAP70 deficiency
Hematologic	Fanconi syndrome , Acanthocytosis , Agammaglobulinemia, alymphocytotic type , Angiofollicular lymph hyperplasia , Athymia, Bare lymphocyte syndrome , CMLLike Syndrome, Familial , Haemoglobin E disease, Hemophagocytic reticulosis , Histiocytosis X, Langerhans Cell Histiocytosis , Severe combined immunodeficiency , Thalassemia
Iatrogenic	No underlying causes
Infectious Disease	AIDS , Ascariasis, Chronic urinary tract infections, Chronic viral infection, Congenital syphilis , Congenital tuberculosis , Mycobacterium tuberculosis, Parasite infestation, Tuberculosis
Musculoskeletal / Ortho	Cantu syndrome, CareyFinemanZiter syndrome, Osteopetrosis with renal tubular acidosis , BallerGerold syndrome, FreemanSheldon Syndrome postnatal growth deficiency, Phocomelia syndrome
Neurologic	HoyeraalHreidarsson syndrome , Ramon syndrome, Rieger Syndrome , Agyria , Alpers Syndrome , Cerebral palsy, Crome syndrome, Diencephalic Syndrome , Encephaloceles , Frynsvan den Berghe syndrome, Gangliosidosis, Hooft disease growth delay
Nutritional / Metabolic	GraeckImerslund disease , Abetalipoproteinaemia, Anorexia nervosa, Forbes disease , Fucosidosis, Galactosemia , Menkes Diseas, , Osteomalacia, Rumination disorder , Food intolerances, Heiner syndrome , 3methylglutaconic aciduria, type 4 , 4Alphahydroxyphenylpyruvate hydroxylase deficiency , 4hydroxyphenylpyruvate hydroxylase deficiency, Acrodermatitis enteropathica , AcylCoA dehydrogenase deficiency , Adenylosuccinate lyase deficiency , Arterial occlusive disease, Chylomicron retention disease, Cystinosis , Dietary deficiencies, Gaucher's disease, GlutarylCoA dehydrogenase deficiency , Glycerol kinase deficiency, GRACILE syndrome, Gylcogen storage disease, Hemosiderosis , Hurler syndrome , Icell disease, Kwashiorkor, Lipoproteine lipase deficiency , Marasmus , MELAS, Methylmalonic acidemia , Nutritional deficiency , Zinc deficiency
Obstetric/Gynecologic	Toxoplasmosis, Rubella, Cytomegalovirus, HSV
Oncologic	Juvenile myelomonocytic leukemia , Leukemia
Opthalmologic	No underlying causes
Overdose / Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	Asthma, Bronchiectasis, Congenital pulmonary alveolar proteinosis , Pulmonary veins stenosis
Renal / Electrolyte	Nephrogenic diabetes insipidus , Aspartylglucosaminuria, Bartter Syndrome , Chronic renal failure, Classic Distal Renal Tubular Acidosis , Hypophosphatasia , Renal failure, LightwoodAlbright syndrome , Nephrotic syndrome, Primary tubular proximal acidosis
Rheum / Immune / Allergy	Crohn's disease, Inflammatory bowel disease, Majeed syndrome , Celiac disease
Sexual	No underlying causes
Trauma	No underlying causes
Urologic	No underlying causes
Dental	No underlying causes
Miscellaneous	Abnormal feeding habits, Child abuse, Neglect, Starvation

In alphabetical order

• 14q+ syndrome

• 18 Hydroxylase deficiency

• 18p minus syndrome

• 1q deletion

• 2q deletion

• 3M syndrome

• 3methylglutaconic aciduria, type 4

• 3q deletion

• 49,XXXXX syndrome

• 4Alphahydroxyphenylpyruvate hydroxylase deficiency

• 4hydroxyphenylpyruvate hydroxylase deficiency

• 4p16.3 deletion

• Aarskog syndrome

• Aase syndrome

• Abetalipoproteinaemia

• Abnormal feeding habits

• ACAD8 deficiency

• Acanthocytosis

• Acrodermatitis enteropathica

• AcylCoA dehydrogenase deficiency

• Adenylosuccinate lyase deficiency

• Adiposogenital dystrophy

• Adrenal hyperplasia, congenital type 3

• Adrenomyodystrophy

• Agammaglobulinemia, alymphocytotic type

• Agyria

• AIDS

• Alagille Syndrome

• AlbersSchonberg disease

• Albright's hereditary osteodystrophy

• Alpers Syndrome

• AlphaLiduronidase deficiency

• Alport Syndrome

• Alsing syndrome

• Aminomethyltransferase deficiency

• Andersen disease

• Angiofollicular lymph hyperplasia

• Anorexia nervosa

• Arginase deficiency

• Arterial occlusive disease

• Ascariasis

• Aspartoacylase deficiency

• Aspartylglucosaminuria

• Asthma

• Athymia

• Atrioventricular septal defect

• Autoimmune enteropathy

• Baber's syndrome

• BallerGerold syndrome

• BardetBiedl syndrome

• Bare lymphocyte syndrome

• Barth syndrome

• Bartter Syndrome

• Bile acid synthesis defects

• BlandGarlandWhite syndrome

• Blind loop syndrome

• Bloom's syndrome

• BonnetDechaumeBlanc syndrome

• BowenConradi syndrome

• BRESHECK syndrome

• Bronchiectasis

• Byler Disease

• C21 hydroxylase deficiency

• CAH

• CAMFAK syndrome

• Campomelic dwarfism

• Cantu syndrome

• CareyFinemanZiter syndrome

• Carnitine transporter deficiency

• Carnosinase deficiency

• Carpenter syndrome

• Celiac disease

• Cerebral palsy

• CHARGE syndrome

• Child abuse

• Chromosome 1, uniparental disomy 1q12 q21

• Chromosome 10 ring syndrome

• Chromosome 10, distal trisomy 10q

• Chromosome 10p deletion syndrome

• Chromosome 11q duplication syndrome

• Chromosome 12 ring syndrome

• Chromosome 12p deletion

• Chromosome 13 ring syndrome

• Chromosome 13 trisomy syndrome

• Chromosome 14 Ring

• Chromosome 14 trisomy

• Chromosome 15 trisomy

• Chromosome 16p, partial duplication

• Chromosome 17 ring

• Chromosome 18 Ring

• Chromosome 19 ring syndrome

• Chromosome 1p deletion syndrome

• Chromosome 2 trisomy syndrome

• Chromosome 20 ring

• Chromosome 20p deletion syndrome

• Chromosome 21 monosomy

• Chromosome 22, trisomy

• Chromosome 2p deletion syndrome

• Chromosome 2p duplication syndrome

• Chromosome 3, trisomy 3p

• Chromosome 3, trisomy 3q

• Chromosome 4 Ring

• Chromosome 4 ring syndrome

• Chromosome 5, trisomy 5q

• Chromosome 5p duplication syndrome

• Chromosome 5p tetrasomy syndrome

• Chromosome 6 ring syndrome

• Chromosome 6, monosomy 6q

• Chromosome 6, trisomy 6q

• Chromosome 7 ring syndrome

• Chromosome 8 recombinant syndrome

• Chromosome 9 trisomy syndrome

• Chromosome 9, trisomy

• Chronic diarrhoea

• Chronic renal failure

• Chronic urinary tract infections

• Chronic viral infection

• Chylomicron retention disease

• Classic Distal Renal Tubular Acidosis

• Classic galactosemia

• Cleft palate

• CMLLike Syndrome, Familial

• Cockayne syndrome

• CoffinLowry syndrome

• Cohen Syndrome

• Complement 5 deficiency

• Complete Trisomy 18 syndrome

• Complex 5 mitochondrial respiratory chain deficiency

• Congenital chloride diarrhea

• Congenital heart disease

• Congenital pulmonary alveolar proteinosis

• Congenital short bowel

• Congenital syphilis

• Congenital tuberculosis

• Congenital Vitamin B12 Malabsorption

• ConradiHuenermann Syndrome

• Cor Triatriatum

• Corpus callosum agenesis

• Criduchat syndrome

• Crohn's disease

• Crome syndrome

• Cushing's syndrome

• Cystic fibrosis

• Cystinosis

• De Barsy syndrome

• Diabetes mellitus

• DiamondBlackfan anemia

• Diencephalic Syndrome

• Dietary deficiencies

• DiGeorge syndrome

• Double outlet right ventricle

• Down syndrome

• Edward Syndrome

• Encephaloceles

• Endocardial fibroelastosis

• Faciocardiorenal syndrome

• Fallot's tetralogy

• Fanconi syndrome

• Farber's disease

• Fetal Hydantoin Syndrome

• Fetal thalidomide syndrome

• Fetal warfarin syndrome

• Filippi syndrome

• Food intolerances

• Forbes disease

• Francois dyscephalic syndrome

• FreemanSheldon Syndrome postnatal growth deficiency

• Frynsvan den Berghe syndrome

• Fucosidosis

• Galactosemia

• Gangliosidosis

• GAPO syndrome

• Gaucher's disease

• Glucocorticoid deficiency

• Glucosegalactose malabsorption

• GlutarylCoA dehydrogenase deficiency

• Glycerol kinase deficiency

• GRACILE syndrome

• GraeckImerslund disease

• Growth hormone deficiency

• Gylcogen storage disease

• Haemoglobin E disease

• Heiner syndrome

• Hemophagocytic reticulosis

• Hemosiderosis

• Hirschsprung's disease

• Histiocytosis X

• Hooft disease growth delay

• HoyeraalHreidarsson syndrome

• Hurler syndrome

• Hyperthyroidism

• Hypoaldosteronism

• Hypophosphatasia

• Hypopituitarism

• Hypothyroidism

• Icell disease

• ICF syndrome

• Iduronate sulphatase deficiency

• Inborn amino acid metabolism disorder

• Inborn urea cycle disorder

• Infantile dysphagia

• Infantile hypophosphatasia

• Infantile Refsum Disease

• Inflammatory bowel disease

• IPEX syndrome

• Ivemark Syndrome

• Jeune's thoracic dystrophy syndrome

• JirasekZuelzerWilson syndrome

• JohansonBlizzard syndrome

• JubergMarsidi syndrome

• Juvenile myelomonocytic leukemia

• Kabuki makeup syndrome

• KaplowitzBodurtha syndrome

• Kartagener's syndrome

• KennyCaffeyLinarelli syndrome

• Kowarski syndrome

• Kwashiorkor

• Langerhans Cell Histiocytosis

• Lead poisoning

• Leigh syndrome

• Leiner Disease

• Leprechaunism

• LeriWeill dyschondrosteosis

• Leukemia

• LightwoodAlbright syndrome

• Lipoproteine lipase deficiency

• Lissencephaly

• Lowe oculocerebrorenal syndrome

• Lowe Syndrome

• LutzRichnerLandolt syndrome

• Majeed syndrome

• Malabsorption syndrome

• Maple syrup urine disease

• Marasmus

• MardenWalker syndrome

• Martsolf syndrome

• MELAS

• Menkes Disease

• Methylmalonic acidemia

• Microvillus Inclusion Disease

• Miescher's syndrome

• Mitochondrial diseases

• MULIBREY Nanism

• Multiple lentigines syndrome

• Mycobacterium tuberculosis

• Navajo neurohepatopathy

• Neglect

• Nephrogenic diabetes insipidus

• Nephrotic syndrome

• Neuronal Migration Disorders

• Nezelof Syndrome

• NiemannPick disease

• NOMID syndrome

• Nutritional deficiency

• Omenn syndrome

• Opitz trigonocephaly syndrome

• Osteogenesis imperfecta

• Osteomalacia

• Osteopetrosis with renal tubular acidosis

• Otopalatodigital syndrome

• Parasite infestation

• Patent ductus arteriosus

• Pearson's anemia

• PelizaeusMerzbacher disease

• Phenylketonuria

• Phocomelia syndrome

• Pierre Robin's sequence

• PittRogersDanks syndrome

• Pompe disease

• PowellBuistStenzel syndrome

• PraderWilli syndrome

• Prednisolone

• Primary tubular proximal acidosis

• Progeroid syndrome, neonatal slow growth

• Progressive familial intrahepatic cholestasis

• Pseudohypoparathyroidism

• Pseudoobstruction idiopathic intestinal

• Pulmonary veins stenosis

• Ramon syndrome

• Renal failure

• Rieger Syndrome

• Rumination disorder

• RussellSilver dwarfism

• SaethreChotzen Syndrome

• SCID

• Seckle syndrome

• Severe combined immunodeficiency

• Sheffield syndrome

• ShwachmanDiamond Syndrome

• Sickle Cell Anemia

• Silver's syndrome

• SingletonMerten Syndrome

• Starvation

• TaySachs disease

• Thalassemia

• Thyroid agenesis

• Thyroid disease

• Transposition of great arteries

• Trisomy 18 Syndrome

• Tuberculosis

• Turner syndrome

• Tyrosinemia

• VATER association

• Velocardiofacial syndrome

• Ventricular septal defect

• Von Gierke disease

• WAGR Syndrome

• Watson syndrome

• Williams syndrome

• Wittwer sydnrome

• WolcottRallison syndrome

• YunisVaron syndrome

• ZAP70 deficiency

• Zinc deficiency

• Toxoplasmosis

• Rubella

• Cytomegalovirus

• HSV

References

External Links

• MAGIC Foundation for Children's Growth

See also

• Failure to thrive
• Short stature
• Dwarfism