Delayed Growth and Puberty

Puberty normally starts between ages 8 and 14 for girls and between 9 and 14 for boys.1 There is a wide variation in normal timing of puberty, depending on factors such as activity level and body fat. However, weight loss or poor weight gain are often seen in young people with inflammatory bowel diseases, and these may slow or limit growth.2 Poor growth, poor weight gain, and delayed puberty are more common with Crohn’s disease than ulcerative colitis.2

Young people with inflammatory bowel disease (IBD) may not feel like eating very much, or they may not be able to digest the food they eat.3 These factors can make weight gain and growth difficult. Corticosteroids, which are medications often used to treat IBD, may increase your appetite, but they also can slow vertical growth.3

Having low body fat can delay puberty in girls.3 Inflammation interferes with hormone levels and this affects puberty. Delayed puberty affects adult height and bone health.3 Socially and emotionally, it also can be difficult for a teen to go through puberty later than his or her peers.

How common is delayed growth and puberty?

Almost 10% of young people have growth failure when they are diagnosed with Crohn’s disease.3 Typical measures of growth failure are being less than the 3rd or 5th percentile for height and/or weight. A study of studies showed that between 7% and 27% continued to have delayed growth at follow-up. On average, girls with Crohn’s disease have a growth spurt about 10 months later than girls without Crohn’s disease.3 For boys with Crohn’s disease, the growth spurt is delayed about 6 months.3

Typically, a woman’s first period happens between ages 8.5 and 13 years.4 In a study of women with Crohn’s disease, nearly three-quarters got their period at or after age 16 years.3

How is delayed growth and puberty evaluated?

Your health care provider will ask questions about your medical history.1 Your provider will be interested in knowing specifically about inflammatory bowel disease and your typical diet. He or she will look at your growth charts, ideally going back to birth. By plotting your growth on the chart, it is possible to tell if you have had a growth spurt.

During the physical examination, your provider will check for changes in genitalia and pubic hair.1 The Tanner staging system is used to describe the stages of puberty. There are 5 stages, based on changes in pubic hair, breast size, and testicular volume.

You may also be asked to do an x-ray to check your bone age. The x-ray reveals how developed or mature your bones are, compared with your chronological age. In one study, the bone age of girls with Crohn’s disease was about 1.3 years behind than their chronological age.3 The bone age of boys with Crohn’s disease was about 0.7 years behind than their chronological age.3

How is delayed growth and puberty treated?

In recent studies, children with inflammatory bowel disease seem to reach average heights as adults.2,3 This outcome suggests that better growth may be one benefit of new medications for IBD. The first step to treating growth delays is to treat the underlying disease. Your health care provider may want to see you regularly to measure your growth.5 This is a way of checking how well treatment is working.

For children with Crohn’s disease, tube feeding (enteral nutrition) starts remission and improves nutritional status. A thin, hollow tube is inserted through your nose into your stomach or small intestine. A nutrient-rich formula flows through the tube. Eight-five percent of children with active Crohn’s disease who receive all their nutrition through tube feeds go into remission.6 Tube feeding helps the intestinal lining heal and improves growth.7 Given these good results, tube feeds can be used instead of corticosteroids for children. Once you are in remission, dietary counseling may be useful to improve or maintain nutrient intake with a normal diet.8 Tube feeding can continue in addition to a normal diet, in some cases.7

If puberty is very delayed, your health care provider may suggest that you see an endocrinologist. An endocrinologist is a doctor that specializes in hormonal imbalances. Treatment options may include testosterone (for boys), estradiol (for girls), or growth hormone.3

Written by: Sarah O'Brien and Emily Downward | Last Reviewed: January 2018.
View References
  1. Blondell RD, Foster MB, Dave KC. Disorders of puberty. Am Fam Physician. 1999;60:209-218, 223-224.
  2. Moeeni V, Day AS. Impact of Inflammatory Bowel Disease upon Growth in Children and Adolescents. ISRN Pediatrics. 2011;2011:365712. doi:10.5402/2011/365712.
  3. DeBoer MD, Denson LA. Delays in puberty, growth, and accrual of bone mineral density in pediatric Crohn's disease: Despite temporal changes in disease severity, the need for monitoring remains. J Pediatr. 2013;163:17-22.
  4. Bharadwaj S, Kulkarni G, Shen B. Menstrual cycle, sex hormones in female inflammatory bowel disease patients with and without surgery. J Dig Dis. 2015;16:245-255.
  5. Gasparetto M, Guariso G. Crohn's disease and growth deficiency in children and adolescents. World J Gastroenterol. 2014;20:13219-13233.
  6. Hartman C, Eliakim R, Shamir R. Nutritional status and nutritional therapy in inflammatory bowel diseases. World J Gastroenterol. 2009;15:2570-2578.
  7. Pappa H, Thayu M, Sylvester F, et al. Skeletal health of children and adolescents with inflammatory bowel disease. J Pediatr Gastroenterol Nutr. 2011;53:11-25.
  8. Donnellan CF, Yann LH, Lal S. Nutritional management of Crohn's disease. Therap Adv Gastroenterol. 2013;6:231-242.