Growth retardation is defined as a condition in which the rate of physical growth (height, weight, or overall development) is slower than the normal standard for age and sex.

• In children, it means failure to achieve expected growth compared to growth charts.
• In fetuses (intrauterine growth retardation, IUGR), it refers to poor growth while in the womb.
• More broadly, it describes delayed or stunted growth due to genetic, nutritional, hormonal, environmental, or disease-related factors.

The causes of growth retardation:

1. Prenatal (before birth) causes

• Maternal factors: malnutrition, smoking, alcohol, drug use, chronic illness (e.g., hypertension, diabetes).
• Placental factors: placental insufficiency, abnormalities of umbilical cord or blood flow.
• Fetal factors: chromosomal abnormalities (e.g., Down syndrome, Turner syndrome), congenital infections (TORCH: toxoplasmosis, rubella, cytomegalovirus, herpes, syphilis).

2. Postnatal causes

• Nutritional deficiencies: protein-energy malnutrition, vitamin/mineral deficiencies.
• Chronic systemic diseases: congenital heart disease, chronic kidney disease, gastrointestinal disorders (celiac disease, inflammatory bowel disease, cystic fibrosis).
• Endocrine disorders:
  • Growth hormone deficiency
  • Hypothyroidism
  • Cushing’s syndrome (excess cortisol)
  • Poorly controlled diabetes
• Genetic/syndromic causes: Turner syndrome, Noonan syndrome, Prader-Willi syndrome, achondroplasia.
• Skeletal abnormalities: rickets, osteogenesis imperfecta.

3. Environmental & psychosocial causes

• Severe neglect, abuse, or lack of emotional nurturing (psychosocial dwarfism).
• Chronic exposure to toxins (e.g., lead, alcohol).
• Poverty and food insecurity.

4. Idiopathic

• Sometimes, no clear cause is found → termed idiopathic short stature or constitutional growth delay (children who grow more slowly but eventually reach normal height after delayed puberty).

The symptoms of growth retardation

General symptoms

• Short stature – height significantly below average for age/sex (often below the 3rd percentile).
• Low weight (if nutritional or systemic disease is present).
• Failure to thrive – poor weight gain and growth in infants/young children.
• Delayed puberty – late onset of secondary sexual characteristics.
• Disproportionate body size (if skeletal dysplasia or rickets).

Additional symptoms depending on cause

• Endocrine causes
  • Hypothyroidism → fatigue, constipation, dry skin, puffiness, delayed milestones.
  • Growth hormone deficiency → increased fat around waist, short stature, normal body proportions.
  • Cushing’s syndrome → round face, obesity, thin limbs, purple stretch marks.
• Nutritional deficiency
  • Thin hair, brittle nails, anemia, irritability, muscle wasting.
• Genetic/syndromic
  • Dysmorphic features (e.g., wide-spaced eyes, webbed neck in Turner syndrome).
  • Developmental delay or intellectual disability (in some syndromes).
• Chronic diseases
  • Recurrent infections, fatigue, poor appetite, abdominal pain (e.g., celiac disease, kidney disease, congenital heart disease).

The treatment of growth retardation:

1. Nutritional management

• Balanced diet rich in protein, vitamins, and minerals.
• Treatment of malnutrition with supplements (iron, zinc, vitamin D, calcium, etc.).
• Nutritionist-guided feeding plans for children with poor intake.

2. Treatment of underlying diseases

• Chronic illnesses (kidney disease, heart disease, celiac disease, inflammatory bowel disease): manage the primary disorder.
• Infections: treat appropriately (e.g., antibiotics, antivirals).
• Endocrine disorders:
  • Growth hormone deficiency → recombinant growth hormone injections.
  • Hypothyroidism → thyroxine replacement therapy.
  • Cushing’s syndrome → treatment of cortisol excess (surgery/medications).

3. Hormone therapy

• Growth hormone therapy → for children with GH deficiency, Turner syndrome, chronic renal insufficiency, Prader-Willi syndrome, and some cases of idiopathic short stature.

4. Psychosocial interventions

• Ensure a healthy, nurturing environment.
• Address neglect or abuse if present.
• Counseling and family support.

5. Genetic/Syndromic causes

• No cure for genetic syndromes, but supportive therapies (hormone treatment, physiotherapy, special education) can improve growth and development.

6. Monitoring

• Regular tracking of growth on standardized growth charts.
• Monitoring puberty, bone age (via X-ray), and nutritional status.