Pediatric respiratory diseases are significantly associated with growth impairment. Through core pathways including chronic hypoxia, systemic inflammation, metabolic dysregulation, and pharmacological interference, these conditions suppress the growth hormone-insulin-like growth factor axis and peripheral signaling, resulting in growth retardation. This article summarizes mechanistic advances regarding growth impairment in obstructive sleep apnea, asthma, chronic lung injury, and recurrent respiratory infections. Accordingly, it discusses intervention strategies encompassing growth monitoring, etiology-targeted therapy, and the standardized use of growth hormone, while highlighting differences from the management of idiopathic short stature. The aim is to elucidate the underlying pathophysiology and provide evidence to optimize clinical management and improve growth outcomes.