BACKGROUND. It is unknown whether children born very preterm (<32 weeks' gestation) with appropriate size for gestational age, who grow poorly in the first postnatal months (ie, preterm growth restraint), show a similar growth pattern as children born small for gestational age. OBJECTIVE. Childhood growth and adult height of children with preterm growth restraint were compared to those of very preterm small-for-gestational-age and non-preterm-growth-restraint children. METHODS. Data were drawn from the Project on Preterm and Small-for-Gestational-Age Infants cohort. Preterm growth restraint was considered to have occurred after appropriate-size-for-gestational-age birth and if length and/or weight was below -2 SD score at 3 months postterm. RESULTS. Among 380 very preterm children, 274 experienced no preterm growth restraint and showed near-normal growth, whereas 79 (21%) experienced preterm growth restraint and subsequently displayed a growth pattern similar to that of very preterm small-for-gestational-age children (n = 27). Adult height of these children was -1.1 to -1.2 SD score. Very preterm small-for-gestational-age and preterm-growth-restraint children with a height below -2 SD score at 5 years had an adult height of approximately -2.5 SD score. CONCLUSIONS. Childhood growth and adult height were similar in very preterm small-for-gestational-age and preterm-growth-restraint children. These long-term findings further strengthen the plausibility of extending the small-for-gestational-age indication for growth hormone therapy in such a way that preterm-growth-restraint children are no longer excluded if they have a short stature persisting beyond the age of ∼5 years. Copyright © 2006 by the American Academy of Pediatrics.