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High dose GC therapy can attenuate physiological growth hormone (GH) secretion via an increase in somatostatin tone, and the GH response to GH stimulation tests may be reversibly impaired in some cases of steroid exposure. Infusion of GC into the growth plate leads to a temporary reduction in the growth rate of that leg and may disrupt the growth plate vasculature. In vitro studies suggest that local somatotrophic action of GH and IGF-1 may be affected by a number of different mechanisms, including alterations in the activity of the GH binding protein, down regulation of GH receptor expression and binding capacity, and a reduction in local IGF-1 production and activity. GC may also impair the attainment of peak bone mass and delay growth through alterations in gonadal function at the level of the pituitary and through direct effects on the gonads. Studies in adults show that GC therapy may be associated with testosterone deficiency as well as reversible gonadotrophin deficiency. Figure 1 summarises the mechanisms of GC induced bone loss and growth retardation. Download figure Open in new tab Download powerpoint. Mechanisms of GC induced bone loss and growth retardation. ASTHMA, ECZEMA, AND HAY FEVER. The increasing incidence and prevalence of childhood atopy and the more widespread use of inhaled steroid therapy for asthma prophylaxis probably accounts for the largest group of children who are chronically exposed to steroids. Oral GC therapy in asthma is associated with a delay in growth and puberty, and there is some evidence to suggest that final height may also be compromised. Although earlier studies did not show a relation between inhaled steroids and growth, there is now good evidence in children with relatively mild asthma that inhaled steroids can temporarily slow growth and alter bone and collagen turnover. The magnitude of this effect may be influenced by the dose delivery system as well as the systemic bioavailability of the inhaled steroid used. Studies of bone mineral density in children with asthma have not shown any significant abnormality but have only concentrated on those children who are on relatively low doses of inhaled steroids. Some intranasal GC such as budesonide have a very high level of systemic absorption when applied directly to the nasal mucosa; short and intermediate term studies of children on intranasal steroids such as budesonide and beclomethasone also show a deterioration in growth velocity. Longitudinal studies show that the growth velocities of children in the year preceding diagnosis are reduced; growth retardation frequently complicates the clinical course in children. In children with inflammatory bowel disease, retardation of growth and skeletal maturation are widely reported and may be related to disease activity as well as to its treatment. 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