In systemic disease, there is often delayed skeletal maturation, but the potential for catch-up growth is present if the underlying systemic disorder can be successfully treated. A child with coeliac disease for example will continue to have stunted growth until gluten is removed from the diet. Other chronic disorders which may also retard growth are Crohn's disease, respiratory disease (e.g. asthma), renal disease, cardiovascular causes, and nutritional causes (e.g. rickets; Fig. 14.15). In all such instances, the potential for catchup growth remains if the disease is rapidly cured. Most children with endocrine disease are obese; therefore, in a child who is not obese, a jejunal biopsy should be performed at an early stage to exclude villous atrophy.
