New research and expert advice highlight that children with nearly closed growth plates may still experience slight height increases, challenging common assumptions and impacting treatment options for delayed growth or early puberty.
Pediatrician Liang Sheng-bin has urged parents not to assume that a child with nearly closed growth plates has already reached their full adult height. Writing on his social media and website, the New Taipei City doctor said that, in many cases, there is still a little growth left, but usually not much.
Liang drew a clear distinction between growth plates that are “nearly closed” and those that are fully closed. Once the cartilage at the ends of the long bones has fully hardened into bone, further natural growth stops. That is consistent with standard paediatric guidance: children’s growth plates are areas of cartilage that gradually turn to solid bone as puberty ends, and once they are completely closed, the bones no longer lengthen.
He also pushed back against a common misconception that all growth plates close at the same time. Liang said research from Sweden, using MRI scans of healthy young people, found that closure happens in stages, generally from the feet upwards, with the wrists among the last areas to finish. That helps explain why a hand X-ray may look close to closure even though other growth plates have already shut.
According to Liang, the real reason height gain slows is that the growth plate itself ages before it disappears. He cited animal studies published in Nature that identified stem cells in the resting zone of the growth plate, which gradually lose their ability to divide as puberty advances. The result is slower height gain first, followed by complete replacement of cartilage with bone. He said the key question for parents is not just whether a gap remains on an X-ray, but how many centimetres the child has actually grown over the past year.
Liang said hormones are central to that ageing process, especially oestrogen, which affects both boys and girls. In boys, testosterone can convert to oestrogen in the body, and it is oestrogen that drives the growth plate towards closure. That is why early puberty can shorten the period of height gain. He added that a 2025 study in the Proceedings of the National Academy of Sciences suggested growth hormone may also encourage these stem cells to mature, which could help explain why treatment effects sometimes diminish over time, although that mechanism has not yet been proven in people.
The doctor said medicines can only work while the growth plates remain open. Drugs used to suppress early puberty or treat certain bone disorders can only act on still-active growth plates, and their room for effect shrinks as the plates age. Once closure is complete, the only way to make bones longer is limb-lengthening surgery. Liang cited a 2025 systematic review of 12 studies involving 760 people who underwent the procedure, with an average gain of 6.7 centimetres and satisfaction rates between 88.8% and 98%. But the review also highlighted common complications, including ankle stiffness, contractures around the knee and ankle, infection at pin sites and poor bone healing.
His message to families was simple: if a child is growing more slowly, or appears to be entering puberty early, assessment should happen sooner rather than later. Growth plates that are nearly closed may still allow a little more height, but the options become limited quickly. Once they are fully closed, there is no medicine that can reopen them.
Disclaimer: This content is for informational purposes only and is not intended to be a substitute for professional medical judgment, advice, diagnosis, or treatment.
