The relationship between elevation of residence and a child's linear growth was studied using data for 8824 children below the age of 5 years born between 2001 and 2016 at elevations ranging from 50 to 3200 m above sea level in Nepal. Multiple regression was used to measure the role of a variety of household and community factors in explaining the observed elevation effect. A negative association was found between elevation and linear growth that varied substantially across the sample but retained a significant marginal effect across model specifications. Controlling for household wealth, access to markets, indoor air quality, and a range of other factors associated with elevation, for each 1000 m gain in elevation, height for age z score (HAZ) declined by between 0.10 and 0.20 points for an average child, and by between 0.35 and 0.42 points for a child with the characteristics of those living at the highest elevations. Results underscore the potential developmental risks for children living at high elevations and call attention to factors that help to mitigate these risks.