Improving general health, sense of well-being, and quality of life are the primary objectives of renal transplanta-tion in children with chronic kidney disease (CKD). Final adult height achieved has a significant impact on medical, psychological, and social aspects of these patients. Growth is an important indicator of health in children with CKD. It seems intuitive then to expect improvement in growth after renal transplantation. Unfortunately, even with a functioning renal allograft, optimal growth remains elusive at times. Optimizing growth prior to transplant, early identification of growth delay, and timely intervention are essential in achieving optimal final adult height. Multiple factors lead to stunted growth in children after renal transplant.