Objectives: Children with childhood-onset systemic lupus erythematosus (cSLE) enter adulthood with considerable morbidity. Of the recognized morbidities, growth failure is unique to cSLE. The aim of this study was to evaluate the growth pattern in children with cSLE longitudinally and identify possible risk factors. Methods: Serial anthropometric measurements of cSLE patients were obtained over two years and expressed as z-scores. Parental heights were obtained to calculate target height. Parent-adjusted height z-score was calculated as the difference between height z-score and target height. Growth failure was defined as parent-adjusted height z-score < -1.50. Risk factors that might have contributed to growth failure were evaluated including the presence of growth failure at baseline, disease activity, disease duration, and cumulative steroid doses. Results: Twentyfive patients were included in the study. Growth failure was observed in eight patients with an overall incidence of 32.0% (95% confidence interval (CI): 14–50%). When comparing the cohort with and without growth failure, the factors that determined growth failure was the pre-existence of growth failure at the time of diagnosis (z-score < -1.95 vs. 0.35; p < 0.001); higher cumulative steroid dose (15.8 vs. 9.1 g ; p = 0.061); and tendency for longer disease duration (5.4 vs. 3.7 years; p = 0.240). However, the severity of disease activity at the time of diagnosis was not a significant contributing factor (12 vs. 14; p = 0.529). Conclusions: Children with cSLE are at risk of having a negative effect on height including patients with pre-existing growth failure, high cumulative steroid dose, and longer disease duration. However, longitudinal prospective studies are needed to examine damage over time to improve health-related quality of life