The prevalence of impaired growth was evaluated in 63 patients with homozygous sickle cell anemia. Twenty-five percent of the children studied were less than the fifth percentile of National Center for Health Statistics growth standards for either height/age, weight/age, or weight/height. Significantly more 11- to 18-year-old children were less than the fifth percentile for weight/height compared with earlier age ranges. No differences due to gender were found. Nutritional intervention may improve growth in selected children.