Approach to growth failure and pubertal delay in children and adolescents with inflammatory bowel disease

IBD: inflammatory bowel disease; BMI: body mass index; SMR: sexual maturity rating (Tanner stage of pubertal development); MRE: magnetic resonance enterography; ESR: erythrocyte sedimentation rate; CRP: C-reactive protein.

* A child has marked acute growth failure if height velocity is <4 cm/year (or <10^th percentile on height velocity charts). Marked chronic growth failure is reflected by decreasing height percentiles over time (eg, crossing 2 curves on a standard height growth chart) and/or predicted height that is substantially lower than genetic potential. Mild growth failure reflects trends that do not meet these thresholds. Refer to UpToDate content on short stature.

¶ Puberty is delayed if there are no signs of pubertal development by approximately 12 to 13 years for females and 13 to 14 years for males. Stalled puberty refers to abnormally slow pubertal progression after pubertal onset, eg, no significant pubertal progression for 2 or more years. Refer to UpToDate content on delayed puberty.