Objectives To develop a prediction model to predict vestibular schwannoma (VS) growth for patients in a wait and scan (W&S) strategy. Design Retrospective cohort study. Setting Tertiary hospital (Radboud university medical center, Nijmegen, the Netherlands). Participants Patients with unilateral VS, entering a W&S strategy and at least one follow‐up MRI available. Data on demographics, symptoms, audiometry and MRI characteristics at time of diagnosis were collected from medical records. Main outcome measures Following multiple imputation, a multivariable Cox regression model was used to select variables, using VS growth (≥2 mm) as outcome. Decision curve analyses (DCA) were performed to compare the model to the current strategy. Results Of 1217 analysed VS patients, 653 (53.7%) showed growth during follow‐up. Balance complaints (HR 1.57 (95% CI: 1.31‐1.88)) and tinnitus complaints in the affected ear (HR 1.36 (95% CI: 1.15‐1.61)), Koos grade (Koos 1 is reference, Koos 2 HR 1.03 (95% CI: 0.80‐1.31), Koos 3 HR 1.55 (95% CI: 1.16‐2.06), Koos 4 HR 2.18 (95% CI: 1.60‐2.96)), time since onset of symptoms (IQR HR 0.83 (95% CI: 0.77‐0.88) and intrameatal diameter on MRI (IQR HR 1.67 (95% CI: 1.42‐1.96)) were selected as significant predictors. The model's discrimination (Harrell's C) was 0.69 (95% CI: 0.67‐0.71), and calibration was good. DCA showed that the model has a higher net benefit than the current strategy for probabilities of VS growth of >12%, 15% and 21% for the first consecutive 3 years, respectively. Conclusions Patients with balance and tinnitus complaints, a higher Koos grade, short duration of symptoms and a larger intrameatal diameter at time of diagnosis have a higher probability of future VS growth. After external validation, this model may be used to inform patients about their prognosis, individualise the W&S strategy and improve (cost‐)effectiveness.