Updated on October 21, 2026
A pediatric growth evaluation is the structured check a pediatric endocrinologist runs when a child is growing more slowly than expected or is much shorter than the family pattern predicts. It combines growth charts, a bone age X-ray, blood tests and family height history. Growth hormone therapy is considered only when that evaluation shows a reason for it, and it is monitored closely once it starts.
This article explains each step of the evaluation and what treatment involves, so parents know what to expect before the first appointment. For the specific diagnosis of short stature without a hormone deficiency, see our page on idiopathic short stature.
What is normal growth in a child?
Growth that follows a steady percentile line on the growth chart and moves toward the height the family history predicts.
A child’s height trajectory is influenced mainly by genetics. Endocrinologists calculate a “family target height,” also called mid-parental height, from the parents’ heights to estimate the expected adult height. Children can sit inside the normal population range and still be well below their own genetic target, and that gap is one of the things an evaluation looks for.
Growth charts put the measurements in context. The CDC growth charts, used for children aged 2 and older, show where a child’s height falls compared with other children of the same age and sex. A percentile is not a grade. A child who tracks consistently along a low percentile may be perfectly healthy. What matters is the pattern over time and how it compares with the genetic target.
What does a pediatric growth evaluation include?
Four things: blood tests, a bone age X-ray, growth velocity, and a review of puberty and family history.
Blood tests
The usual panel includes IGF-1 and IGFBP-3, which reflect growth hormone activity in the body, plus thyroid function, glucose, HbA1c and liver function to rule out other causes of slow growth. Normal IGF-1 and IGFBP-3 levels make true growth hormone deficiency less likely, but they do not by themselves settle whether treatment is appropriate. The Pediatric Endocrine Society guideline also advises against relying on growth hormone stimulation test results as the only criterion for a deficiency diagnosis.
Bone age X-ray
A single X-ray of the left hand and wrist shows how mature the growth plates are. When bone age matches the child’s actual age, the growth plates are developing on schedule. When bone age is mildly delayed, it can point to constitutional delay, a pattern in which children grow slowly early and catch up later. Both findings are common in children evaluated for short stature, and delayed bone age also means there is more growing time left.
Growth velocity
Growth velocity is how many centimeters a child grows per year, measured at visits spaced several months apart. A normal velocity with a low-normal height usually means the child is not growth hormone deficient. A velocity that has slowed is a stronger reason to investigate.
Puberty stage and family history
Tanner staging records where a child is in puberty, which affects how much growth is still ahead. Parents’ heights and the timing of their own growth spurts complete the picture.
When is growth hormone therapy considered for a child?
When the evaluation shows growth hormone deficiency, or when a child is far below the expected height for the family with no other cause found, which is called idiopathic short stature.
Growth hormone deficiency is the clearest indication. Idiopathic short stature is more nuanced. The Pediatric Endocrine Society calls it a controversial indication and recommends a shared decision between the family and the doctor, with a restrained dosing strategy and a review of the effect on height and the child’s wellbeing after 12 months of treatment.
Aromatase inhibitors and puberty blockers are sometimes discussed for teenagers whose growth plates are closing early. Most children with low-normal height and a normal bone age do not need them, and they are not part of standard growth hormone treatment. Read more about growth hormone for kids.
How is pediatric growth hormone therapy given and monitored?
As a small injection once a day, usually in the evening, with a dose set by the endocrinologist and reviewed at follow-up visits.
Doses are individual. They depend on the child’s weight, diagnosis and response, and they are adjusted at follow-up visits using IGF-1 results and growth velocity. Daily use matters: missed doses reduce the effect and slow growth. Endocrinologists consistently name adherence as one of the strongest predictors of a good outcome.
Follow-up typically includes:
- IGF-1 levels at regular intervals, usually every 6 months
- Thyroid function, glucose and HbA1c
- Bone age X-ray every 6 to 12 months
- Height and growth velocity at every visit
- Puberty stage
- Checks for the known but uncommon side effects: headaches with vision changes (intracranial hypertension), hip or knee pain (slipped capital femoral epiphysis), and scoliosis progression
What results can parents expect?
A faster growth rate in the first year, then a gradual move toward the family’s expected height range.
Growth hormone therapy does not make a child taller than their genetics allow. Its purpose is to help a child reach the adult height their family pattern predicts. Progress is judged on growth velocity and bone age, not on a single measurement. Current prices are on our cost of growth hormone therapy for kids page.
Quick summary for parents
Many parents worry when their child looks shorter than classmates. A growth check with a pediatric endocrinologist tells you whether your child is growing as expected. The doctor looks at:
- Growth charts (percentiles)
- A bone age X-ray
- Hormone levels, especially IGF-1
- How many centimeters your child grows each year
- Family height patterns
Even when lab results are normal, some children grow much more slowly than their genetic target. In those cases, growth hormone therapy may be an option, decided together with your doctor.
Treatment is a small injection once each night. Children usually tolerate it well. The doctor adjusts the dose at follow-up visits and checks IGF-1, thyroid, blood sugar, bone age and puberty stage to keep treatment safe. Most children grow faster once treatment starts. The goal is not to make a child unusually tall. It is to help them reach their full potential.
If you are concerned about your child’s growth, an evaluation gives you clarity. Our pediatric endocrinologist, Dr. Adrian Eduardo Cuenca Bravo, reviews every pediatric case at HGH Vallarta.
Sources
- Centers for Disease Control and Prevention. Growth Charts. https://www.cdc.gov/growthcharts/index.htm
- Grimberg A, DiVall SA, 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. Horm Res Paediatr. 2016;86(6):361-397. https://doi.org/10.1159/000452150
- Grimberg A, Allen DB. Growth hormone treatment for growth hormone deficiency and idiopathic short stature: new guidelines shaped by the presence and absence of evidence. Curr Opin Pediatr. 2017;29(4):466-471. https://pmc.ncbi.nlm.nih.gov/articles/PMC5565215/
