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Has Teen Stopped Growing?

Pediatrics Expert Advice from Shari Nethersole, M.D.

Q: My 14-year-old son recently fractured his middle finger. An x-ray revealed not only the fracture, but a lack of growth plates in the wrist. This prompted the orthopedist to tell my son that he had reached his full stature at 5'7" tall. The insensitivity issue aside, is it a medical certainty that because the growth plate in one wrist has fused he will grow no taller?

A: Predicting growth can be a little tricky. While it is true that once a growth plate has fused there will be no lengthening of that bone, not all the growth plates in the body fuse at the same time. Some bones, like the small bones of the wrist and feet, might fuse while other bones in the body still have open growth plates. Height will be determined primarily by the growth in the bones of the legs and the spine at this time. It is quite possible that the small bones in the wrist have closed while the growth plates in the legs are still open, and that would allow for continued increases in height. You wouldn't know for sure unless you looked at an x-ray of the legs.

That said, hand and wrist x-rays are a standard use as a predictor of skeletal maturity in children, so it may be that your son has finished growing. The growth plates in the knees generally close at about the same time as the ones in the wrist. The usual progression of fusion of growth plates is elbow first, then foot and ankle, then hand and wrist, then knee, then hip and pelvis, and last the shoulder and clavicle. It is possible that he has finished, however 14 would be quite early for a boy to stop growing, unless he has gone through puberty early. Most boys don't stop growing until about age 17.

The main factor that determines when the growth plates fuse is the rise in various hormones that takes place with puberty. Testosterone, which is the major hormone in boys, promotes growth as well as maturation of bone, eventually causing the growth plates to fuse. For boys, the growth spurt occurs fairly late in puberty, after there is already a fair amount of pubic hair and the penis and testes have enlarged to almost their full size. If your son is more in the middle of puberty, it is likely that he still has some growth in height left, in spite of a wrist that is no longer growing. If your son has already gone completely through puberty, it is more likely that he has finished growing. Your son's doctor can assess this more at his next visit.

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Shari Nethersole is a physician at Children's Hospital, Boston, and an instructor in Pediatrics at Harvard Medical School. She graduated from Yale University and Harvard Medical School, and did her internship and residency at Children's Hospital, Boston. As a pediatrician, she tries to work with parents to identify and address their concerns.


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