Purpose: The purpose of this paper is to focus on the early development of eHealth service start-ups. To elaborate the research problem, the study addresses the following research questions: How do managerial experiences in eHealth service start-ups relate to the central findings of the recent empirically based stages-of-growth literature? What context-specific viewpoints should be considered when using the stage framework in relation to eHealth service start-ups? Design/methodology/approach: In this explorative multiple case study, the authors test a growth framework describing the early stages of eHealth service firms through eight case studies. The authors utilise the critical incident technique and semi-structured interviews in the data collection. Findings: When taking into account the key contradictions assessed in the study as well as context-specific features of eHealth businesses, the empirically based stage framework seems to be a useful starting point for reflecting on and predicting the challenges faced during the early development of eHealth service start-ups. Slow growth due to several factors and the essential role of the public sector were commonly emphasised elements of the context-specific viewpoints of the eHealth service business. Practical implications: The results may be used in start-ups and intermediary organisations as a framework for predicting managerial challenges during the start-up stage of an eHealth service business. Originality/value: Numerous universal models and frameworks have attempted to clarify management priorities during the early stages of business. However, context-specific viewpoints and their effects on start-ups have not been broadly studied. This study provides new insights into growth management in the eHealth context.