Research during the last decade shows clearly that growth hormone (GH) therapy causes a sustained increase in growth velocity when applied to short children born small for gestational age (SGA). This occurs even though GH deficiency per se is an unlikely explanation for their lack of catch-up growth. In the United States, children born weighing less than –2 SD for gestational age and who show no growth recovery (usually defined as stature persisting below –2 SD at age 2 years) are eligible for GH treatment using doses up to 0.48 mg/kg per week. The management of these children brings new challenges to the pediatric endocrinologist. Intrauterine growth retardation reflects a variety of etiologies, some of which merit special consideration and may respond variably to GH. The dose of GH used exceeds physiologic replacement and is higher than that commonly used to treat other non-GH-deficient conditions such as Turner syndrome. Thus, what constitutes optimal therapy in terms of dose, timing and patient selection remains an important question. While GH therapy provides a means by which one aspect of the SGA syndrome can be helped, there are other issues for SGA apart from height. Future efforts should include studies that better define how GH should be used in the short child born SGA and address more broadly the medical, social and psychological needs of these patients.