Constitutional Growth Delay (CGD)—also known as constitutional delay of growth and puberty—is one of the most common reasons children are shorter than their peers. It is a benign, non-disease growth pattern in which a child grows normally, just on a later timeline than average.
Most importantly: children with CGD almost always reach a normal adult height.
This guide explains what CGD is, why it happens, how doctors diagnose it, and when parents should consider a pediatric endocrinology evaluation.
Children with Constitutional Growth Delay typically:
were normal size at birth
slow down in height around ages 2–4
grow steadily but stay short compared with peers
enter puberty later than classmates
experience a delayed—but strong—pubertal growth spurt
reach a normal or near-normal adult height
Constitutional Growth Delay is a normal variant of growth—not a disease or endocrine disorder.
Children with CGD follow a healthy growth pattern, but their biological clock runs slower.
The delay affects:
Bone age (delayed vs. actual age)
Puberty timing
Growth spurt timing
Because their bones are younger, these children still have more time left to grow, even when peers have finished. You can read more about what a bone age is here.
CGD is strongly linked to genetics and family patterns.
At least one parent often reports:
“I was the shortest kid in my class.”
“I didn’t hit puberty until high school.”
“I grew after senior year.”
This inherited timing difference affects how quickly the growth plates mature but does not indicate disease.
There is no evidence that nutrition, hormones, illness, or environmental exposures cause constitutional delay.
Parents often notice:
Typically below the 3rd–10th percentile, while weight may be normal.
Children grow consistently each year, just at a steady pace.
Boys may not show testicular growth until 13–14.
Girls may not begin breast development until 12–13.
Kids may look younger than their classmates due to delayed bone maturation.
This is one of the strongest clues.
Diagnosis must be made carefully, because CGD looks similar to several medical disorders early on.
Evaluation typically includes:
A simple X-ray of the left hand/wrist tells us the biological age of a child’s growth plates.
Bone age younger than actual age → consistent with CGD
Bone age equal to actual age → consider other diagnoses
A delayed bone age means more growth potential remains, which is why CGD children often “catch up” later. You can learn more about when growth plates close here.
Doctors look at how quickly a child grows yearly.
In CGD, velocity is normal (5–6 cm/year before puberty).
To rule out other causes of short stature, physicians may check:
Thyroid levels
Growth hormone pathways (IGF-1)
Celiac screening
Inflammatory markers
Most children with CGD have relatively normal labs.
| Feature | CGD | Growth Hormone Deficiency |
|---|---|---|
| Bone Age | Delayed | Delayed or normal |
| Puberty | Delayed | Often delayed |
| Growth Velocity | Normal | Low |
| Labs | Normal | Abnormal GH/IGF-1 |
| Final Height | Normal | Often short without treatment |
Because both conditions can appear similar, evaluation by a pediatric endocrinologist is essential.
Yes — almost all children with CGD achieve normal adult height.
Typical CGD timeline:
Ages 2–4: growth slows
Ages 4–12: steady but below peers
Ages 12–15: delayed puberty
Ages 14–17: late but strong growth spurt
Ages 16–20: continued catch-up growth
Many patients grow significantly after classmates stop.
Seek an evaluation if your child:
is significantly shorter than peers
shows no signs of puberty by age 13 (girls) or 14 (boys)
has a concerning growth velocity (<4 cm/year before puberty)
has chronic medical symptoms
has a normal bone age but remains very short
you simply need clarity, reassurance, and a professional growth plan
No. It is a normal growth variant, not a medical disorder.
Rarely. Most children grow normally on their own.
Only if your child has another condition. CGD alone does not require GH therapy.
Almost always no. Kids with CGD have extra years of growth due to delayed bone maturation.
Typically 1–2 years later than average—but still normal.
If you’re worried about your child’s height or puberty timing, a growth evaluation can provide clarity and a precise plan.
Schedule a Growth & Puberty Consultation with Life Pediatric Endocrinology—the nation’s leader in integrative, evidence-based pediatric endocrinology.
Our specialists analyze bone age, growth velocity, hormones, nutrition, and genetics to give your family answers and confidence.
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.
Allen DB, Cuttler L. Short Stature in Childhood — Challenges and Choices. NEJM 2013; 368(13):1220–8.
Raivio T, Miettinen PJ. Constitutional Delay of Puberty Versus Congenital Hypogonadotropic Hypogonadism. Best Pract Res Clin Endocrinol Metab 2019; 33(3):101316.
Barroso PS et al. Clinical and Genetic Characterization of a CDGP Cohort. Neuroendocrinology 2020; 110(11–12):959–966.