What Is Constitutional Growth Delay?

Understanding the “Late Bloomer” Pattern in Kids— What Is Constitutional Growth Delay (CGD)?

Constitutional growth delay — also called constitutional delay of growth and puberty (CDGP) — is a benign and common cause of short stature during childhood. Children with CGD grow more slowly early in life and enter puberty later than their peers, but they eventually catch up and achieve a normal or near-normal adult height.

These children are often described as “late bloomers.” They’re healthy overall, with:

• Normal birth weight and length

• A slowdown in growth during early childhood

• Height below the 3rd percentile for age through much of childhood

• Delayed puberty, followed by a normal growth spurt later on

Because their bone age — a measure of skeletal maturity — is behind their chronological age, they still have time to grow even when peers have already hit their peak height. You can read more about what is bone age here.

How Is CGD Different from Other Causes of Short Stature?

Unlike hormonal or genetic disorders, CGD is not a disease. Children maintain a normal growth velocity for their bone age and don’t have evidence of:

• Chronic illness

• Thyroid or growth-hormone deficiency

• Genetic syndromes or chromosomal abnormalities

A family history of “late bloomers” often provides a helpful clue — many parents of children with CGD recall their own delayed puberty or smaller size during adolescence.

Diagnosing Constitutional Growth Delay

A pediatric endocrinologist evaluates growth using:

1. Growth charts to track height over time

2. Bone-age X-rays to compare skeletal maturity with chronological age

3. Laboratory testing to rule out other endocrine or systemic conditions

Treatment and Support

Most children with CGD need no medical treatment — just reassurance and monitoring. However, if the delay causes psychosocial stress (for example, when peers are developing much earlier), a short course of low-dose hormone therapy may be considered to jump-start puberty safely under endocrinology supervision. You can read more about LIFE's integrative approach here.

Ongoing follow-up ensures:

• Continued normal growth velocity

• Timely onset of puberty

• Emotional support for the child and family

At Life Pediatric Endocrinology, we take a compassionate, whole-child approach — combining growth data, hormone insight, nutrition, and emotional well-being to guide families confidently through every stage.

Frequently Asked Questions (FAQ)

1. Is constitutional growth delay genetic?
Yes. CGD often runs in families. If one or both parents were “late bloomers,” their child may follow the same pattern.

2. How is bone age different from chronological age?
Bone age shows how mature a child’s skeleton is compared with their calendar age. Children with CGD typically have a younger bone age, meaning their growth plates remain open longer — allowing for more growth later.

3. Can constitutional growth delay affect adult height?
In most cases, no. Children with CGD usually reach a normal or near-normal adult height, though they get there later than peers. However, there are options to ensure your child remains on their trajectory.

4. When should I see a pediatric endocrinologist?
If your child’s growth slows significantly, their height drops below the 3rd percentile, or puberty hasn’t begun by age 13 in girls or age 14 in boys, schedule a growth and puberty evaluation. If your child is feeling the psychosocial impacts of not "fitting in with their peers", we would love the opportunity to discuss intervention options to ensure your child reaches their full potential.

Key Takeaways

• Normal labs, delayed bone age, and family history support the diagnosis.

• Reassurance and monitoring are the main treatments.

• Hormonal therapy is rarely needed, used only for psychosocial concerns.

Ready to Understand Your Child’s Growth?

If your child’s growth seems slower than expected, don’t wait and wonder. Schedule a Growth and Puberty Consultation at Life Pediatric Endocrinology. Our team specializes in distinguishing healthy variants like CGD from medical causes of short stature — giving families answers, confidence, and peace of mind.

👉 Book a Consultation

About the Author

Dr. Kelli Davis, DO is a board-certified pediatric endocrinologist at Life Pediatric Endocrinology. Trained at Vanderbilt University, she specializes in growth, puberty, and bone health. Dr. Davis is passionate about helping families understand their child’s growth journey and make informed decisions with clarity and confidence.

References

1. Allen DB, Cuttler L. Short Stature in Childhood — Challenges and Choices. NEJM 2013; 368(13):1220–8.

2. Raivio T, Miettinen PJ. Constitutional Delay of Puberty Versus Congenital Hypogonadotropic Hypogonadism. Best Pract Res Clin Endocrinol Metab 2019; 33(3):101316.

3. Barroso PS et al. Clinical and Genetic Characterization of a CDGP Cohort. Neuroendocrinology 2020; 110(11–12):959–966.