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The child with tall stature or abnormally rapid growth


Statural growth, a fundamental characteristic of childhood, is a complex process that is determined by the interaction of genetics, nutrition, and socioeconomic factors [1]. Regular assessment of growth is an essential part of pediatric practice. The importance of comparing a child's growth pattern to established norms cannot be overemphasized. Because growth is an active process, growth velocity charts are more useful than are standard (distance) growth charts in determining the normality of growth [2]. However, in interpreting a child's growth velocity, allowance must be made for age, pubertal development, and other factors.

The causes, diagnosis, and treatment of children with abnormally rapid growth and tall stature will be reviewed here. The evaluation of children with short stature is discussed elsewhere. (See "Causes of short stature" and "Diagnostic approach to children and adolescents with short stature".)


Before considering abnormal growth, one should understand normal growth and development. (See "Normal growth patterns in infants and prepubertal children", section on 'Linear growth'.)

Growth velocity — In both boys and girls, peak growth velocity occurs during the fourth month of intrauterine life, reaching 2.5 cm/week (130 cm/year) [3], followed by a slowing until birth. In the first year of life, linear growth remains rapid; approximately 25 cm is gained. The rate of growth declines, and the average gain is 12.5 cm/year between the first and the second year, 7 cm/year between ages two and four, 6 cm/year between ages four and six, and then 5.5 cm/year until puberty.

The second acceleration in height velocity takes place at puberty. Girls have their peak height velocity (mean 9 cm/year) during early puberty (Tanner stages II to III) (figure 1A), whereas boys reach their peak height velocity (mean, 10.3 cm/year) during mid-puberty (Tanner stages III to IV) (figure 1B) [4,5]. After the pubertal growth spurt, growth velocity diminishes toward zero as the epiphyses of the long bones fuse [6].


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Literature review current through: Mar 2014. | This topic last updated: Sep 30, 2013.
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  1. Reiter EO, Rosenfeld RG. Normal and aberrant growth. In: Williams Textbook of Endocrinology, Wilson JD, Foster DW, Kronenberg HM, Larsen PR (Eds), Saunders, Philadelphia 1998. p.1427.
  2. Brook CG, Hindmarsh PC, Healy MJ. A better way to detect growth failure. Br Med J (Clin Res Ed) 1986; 293:1186.
  3. Lifshitz F, Cervantes CD. Short stature. In: Pediatric Endocrinology, Lifshitz F (Ed), Marcel Dekker, New York 1996. p.3.
  4. Tanner JM, Whitehouse RH, Takaishi M. Standards from birth to maturity for height, weight, height velocity, and weight velocity: British children, 1965. II. Arch Dis Child 1966; 41:613.
  5. Tanner JM, Whitehouse RH. Clinical longitudinal standards for height, weight, height velocity, weight velocity, and stages of puberty. Arch Dis Child 1976; 51:170.
  6. Styne D. Growth. In: Basic and Clinical Endocrinology, Greenspan FS, Strewler GJ (Eds), Appleton and Lange, Connecticut 1997. p.157.
  7. HEALY MJ, LOCKHART RD, MACKENZIE JD, et al. Aberdeen growth study. I. The prediction of adult body measurements from measurements taken each year from birth to 5 years. Arch Dis Child 1956; 31:372.
  8. Tanner JM. Fetus into Man: Physical Growth from Conception to Maturity, Harvard University Press, Cambridge 1989.
  9. Greulich WW, Pyle SI. Radiographic Atlas of Skeletal Development of the Hand and Wrist, Stanford University Press, Stanford 1950.
  10. Tanner JM, Whitehouse RH, Cameron N, et al. Assessment of Skeletal Maturity and Prediction of Adult Height (TW2 Method), Academic Press, London 1983.
  11. BAYLEY N, PINNEAU SR. Tables for predicting adult height from skeletal age: revised for use with the Greulich-Pyle hand standards. J Pediatr 1952; 40:423.
  12. Hochberg Z, Ritzen M. Tall Stature. In: Practical Algorithms in Pediatric Endocrinology, Hochberg Z (Ed), Karger, Basel, Switzerland 1999.
  13. de Waal WJ, Greyn-Fokker MH, Stijnen T, et al. Accuracy of final height prediction and effect of growth-reductive therapy in 362 constitutionally tall children. J Clin Endocrinol Metab 1996; 81:1206.
  14. Drop SL, De Waal WJ, De Muinck Keizer-Schrama SM. Sex steroid treatment of constitutionally tall stature. Endocr Rev 1998; 19:540.
  15. Mercurio MR, Ehrenkranz RA. Infants of diabetic mothers. In: Therapy for Diabetes Mellitus and Related Disorders, Lebovitz HE (Ed), American Diabetes Association, Alexandria 1998.
  16. Blizzard RM, Johanson A. Disorders of growth. In: The Diagnosis and Treatment of Endocrine Disorders in Childhood and Adolescence, Kappy MS, Blizzard RM, Migeon CJ (Eds), Thomas, Illinois 1994.
  17. Barnes-Powell LL. Infants of diabetic mothers: the effects of hyperglycemia on the fetus and neonate. Neonatal Netw 2007; 26:283.
  18. Sotos JF, Cutler EA, Dodre P. Cerebral gigantism. Am J Dis Child 1977; 131:625.
  19. Agwu JC, Shaw NJ, Kirk J, et al. Growth in Sotos syndrome. Arch Dis Child 1999; 80:339.
  20. Cole TR, Hughes HE. Sotos syndrome: a study of the diagnostic criteria and natural history. J Med Genet 1994; 31:20.
  21. Weng EY, Moeschler JB, Graham JM Jr. Longitudinal observations on 15 children with Wiedemann-Beckwith syndrome. Am J Med Genet 1995; 56:366.
  22. Shuman C, Smith AC, Weksberg R. Beckwith-Wiedemann Syndrome. GeneReviews, 2008. (Accessed on April 08, 2010).
  23. Choufani S, Shuman C, Weksberg R. Beckwith-Wiedemann syndrome. Am J Med Genet C Semin Med Genet 2010; 154C:343.
  24. Klein KO. Precocious puberty: who has it? Who should be treated? J Clin Endocrinol Metab 1999; 84:411.
  25. Sotos JF. Overgrowth. Hormonal Causes. Clin Pediatr (Phila) 1996; 35:579.
  26. Schlesinger S, MacGillivray MH, Munschauer RW. Acceleration of growth and bone maturation in childhood thyrotoxicosis. J Pediatr 1973; 83:233.
  27. Smith EP, Boyd J, Frank GR, et al. Estrogen resistance caused by a mutation in the estrogen-receptor gene in a man. N Engl J Med 1994; 331:1056.
  28. Morishima A, Grumbach MM, Simpson ER, et al. Aromatase deficiency in male and female siblings caused by a novel mutation and the physiological role of estrogens. J Clin Endocrinol Metab 1995; 80:3689.
  29. Thistlethwaite D, Darling JA, Fraser R, et al. Familial glucocorticoid deficiency. Studies of diagnosis and pathogenesis. Arch Dis Child 1975; 50:291.
  30. Coulter JB, Diver MJ, Isherwood DM, et al. Tall stature in isolated glucocorticoid deficiency: A case report and review of the literature. J Pediatr Endocrinol 1991; 4:271.
  31. Chung TT, Chan LF, Metherell LA, Clark AJ. Phenotypic characteristics of familial glucocorticoid deficiency (FGD) type 1 and 2. Clin Endocrinol (Oxf) 2010; 72:589.
  32. van Rossum EF, Lamberts SW. Glucocorticoid resistance syndrome: A diagnostic and therapeutic approach. Best Pract Res Clin Endocrinol Metab 2006; 20:611.
  33. SEIP M. Lipodystrophy and gigantism with associated endocrine manifestations. A new diencephalic syndrome? Acta Paediatr 1959; 48:555.
  34. Huseman C, Johanson A, Varma M, Blizzard RM. Congenital lipodystrophy: An endocrine study in three siblings. I. Disorders of carbohydrate metabolism. J Pediatr 1978; 93:221.
  35. Garg A, Agarwal AK. Lipodystrophies: disorders of adipose tissue biology. Biochim Biophys Acta 2009; 1791:507.
  36. Forbes GB. Nutrition and growth. J Pediatr 1977; 91:40.
  37. Biro FM, Khoury P, Morrison JA. Influence of obesity on timing of puberty. Int J Androl 2006; 29:272.
  38. Sotos JF. Genetic disorders associated with overgrowth. Clin Pediatr (Phila) 1997; 36:39.
  39. Robinson A, Lubs HA, Nielsen J, Sørensen K. Summary of clinical findings: profiles of children with 47,XXY, 47,XXX and 47,XYY karyotypes. Birth Defects Orig Artic Ser 1979; 15:261.
  40. Dietz HC, Cutting GR, Pyeritz RE, et al. Marfan syndrome caused by a recurrent de novo missense mutation in the fibrillin gene. Nature 1991; 352:337.
  41. Hayward C, Porteous ME, Brock DJ. Mutation screening of all 65 exons of the fibrillin-1 gene in 60 patients with Marfan syndrome: report of 12 novel mutations. Hum Mutat 1997; 10:280.
  42. Fowler B, Jakobs C. Post- and prenatal diagnostic methods for the homocystinurias. Eur J Pediatr 1998; 157 Suppl 2:S88.
  43. Mudd SH, Skovby F, Levy HL, et al. The natural history of homocystinuria due to cystathionine beta-synthase deficiency. Am J Hum Genet 1985; 37:1.
  44. Ferner RE, Huson SM, Thomas N, et al. Guidelines for the diagnosis and management of individuals with neurofibromatosis 1. J Med Genet 2007; 44:81.
  45. Carmi D, Shohat M, Metzker A, Dickerman Z. Growth, puberty, and endocrine functions in patients with sporadic or familial neurofibromatosis type 1: a longitudinal study. Pediatrics 1999; 103:1257.
  46. Josefson J, Listernick R, Fangusaro JR, et al. Growth hormone excess in children with neurofibromatosis type 1-associated and sporadic optic pathway tumors. J Pediatr 2011; 158:433.
  47. Joss EE, Temperli R, Mullis PE. Adult height in constitutionally tall stature: accuracy of five different height prediction methods. Arch Dis Child 1992; 67:1357.
  48. Blum WF, Albertsson-Wikland K, Rosberg S, Ranke MB. Serum levels of insulin-like growth factor I (IGF-I) and IGF binding protein 3 reflect spontaneous growth hormone secretion. J Clin Endocrinol Metab 1993; 76:1610.
  49. Tauber M, Pienkowski C, Rochiccioli P. Growth hormone secretion in children and adolescents with familial tall stature. Eur J Pediatr 1994; 153:311.
  50. Thomsett MJ. Referrals for tall stature in children: a 25-year personal experience. J Paediatr Child Health 2009; 45:58.
  51. Rayner JA, Pyett P, Astbury J. The medicalisation of 'tall' girls: A discourse analysis of medical literature on the use of synthetic oestrogen to reduce female height. Soc Sci Med 2010; 71:1076.
  52. Venn A, Bruinsma F, Werther G, et al. Oestrogen treatment to reduce the adult height of tall girls: long-term effects on fertility. Lancet 2004; 364:1513.
  53. Bruinsma FJ, Venn AJ, Patton GC, et al. Concern about tall stature during adolescence and depression in later life. J Affect Disord 2006; 91:145.
  54. Bierich JR. Estrogen treatment of girls with constitutional tall stature. Pediatrics 1978; 62:1196.
  55. Sorgo W, Scholler K, Heinze F, et al. Critical analysis of height reduction in oestrogen-treated tall girls. Eur J Pediatr 1984; 142:260.
  56. Frank GR. The role of estrogen in pubertal skeletal physiology: epiphyseal maturation and mineralization of the skeleton. Acta Paediatr 1995; 84:627.
  57. Wettenhall HN, Cahill C, Roche AF. Tall girls: a survey of 15 years of management and treatment. J Pediatr 1975; 86:602.
  58. Prader A, Zachmann M. Treatment of excessively tall girls and boys with sex hormones. Pediatrics 1978; 62:1202.
  59. Bailey JD, Park E, Cowell C. Estrogen treatment of girls and constitutional tall stature. Pediatr Clin North Am 1981; 28:501.
  60. Pyett P, Rayner J, Venn A, et al. Using hormone treatment to reduce the adult height of tall girls: are women satisfied with the decision in later years? Soc Sci Med 2005; 61:1629.
  61. Zachmann M, Ferrandez A, Můrset G, Prader A. Estrogen treatment of excessively tall girls. Helv Paediatr Acta 1975; 30:11.
  62. Hendriks AE, Drop SL, Laven JS, Boot AM. Fertility of tall girls treated with high-dose estrogen, a dose-response relationship. J Clin Endocrinol Metab 2012; 97:3107.
  63. Reinehr T, Gueldensupp M, Wunsch R, Bramswig JH. Treatment of tall stature in boys: comparison of two different treatment regimens. Horm Res Paediatr 2011; 76:343.
  64. Noordam C, van Daalen S, Otten BJ. Treatment of tall stature in boys with somatostatin analogue 201-995: effect on final height. Eur J Endocrinol 2006; 154:253.
  65. Carel JC, Blumberg J, Bougeard-Julien M, et al. Long-acting lanreotide in adolescent girls with constitutional tall stature. Horm Res 2009; 71:228.