Growth

For years, doctors have used height and weight measurements to assess a child’s physical growth in relation to other kids the same age. Now they have another tool: body mass index (BMI).

BMI is a calculation that uses height and weight to estimate how much body fat someone has. Doctors use it to determine how appropriate a child’s weight is for a certain height and age.

Calculating BMI

You can use the BMI calculator below to find your child’s BMI, but it’s also important to have your doctor do regular BMI measurements. That way, you’ll know the number is accurate and the doctor can discuss the results with you.

Tracking BMI

Starting when your child is 2 years old, the doctor will determine BMI at routine checkups and plot this measurement on a chart against those of other kids the same age.

Because what is normal changes with age, doctors must plot children’s BMI measurements on standard growth charts rather than using a universal normal range for BMI as is done with adults. They also use separate charts for boys and girls to account for differences in growth rates and amounts of body fat as the two genders mature.

That information is recorded in your child’s medical record. Over several visits, the pattern of measurements allows the doctor to track your child’s growth.

BMI is particularly helpful for identifying kids and adolescents who are at risk for becoming significantly overweight as they get older. In older kids and teens, there is a strong connection between BMI and the amount of body fat. So those with high BMI readings — and, probably, high levels of fat — are most likely to have weight problems when they are older.

By identifying these at-risk kids, doctors can monitor their body fat carefully and try to prevent adult obesity through changes in eating and exercise habits.

What the Figures Mean

BMI percentiles show how kids’ measurements compare with others the same gender and age. For example, if a child has a BMI in the 60th percentile, 60% of the kids of the same gender and age who were measured had a lower BMI.

BMI is not perfect. For example, it’s very common for kids to gain weight quickly — and see their BMI go up — during puberty. Your doctor can help you figure out whether this weight gain is a normal part of development or whether it’s something to be concerned about.

Kids also can have a high BMI if they have a large frame or a lot of muscle, not excess fat. And a kid with a small frame may have a normal BMI but too much body fat.

Although BMI is not a direct or perfect measure of body fat, kids at or above the 95th percentile are considered obese, a term doctors use to indicate excess body fat, which increases the risk of weight-related health problems.

Kids who measure at the 85th to 94th percentiles are considered overweight, because of excess body fat or high lean body mass. A child whose BMI is between the 5th percentile to 85th percentile is in the healthy weight range. A child with a BMI below the 5th percentile is considered underweight.

Also, it’s important to look at the BMI numbers as a trend instead of focusing on individual numbers. Any one measurement, taken out of context, can give you the wrong impression of your child’s growth.

The real value of BMI measurements lies in viewing them as a pattern over time. That allows both doctor and parents to watch a child’s growth and determine whether it’s normal compared with that of other kids the same age.

While BMI is an important indicator of healthy growth and development, if you think your child may be gaining or losing weight too fast, talk to your doctor.

There’s been a lot of discussion over the years about the proper way to refer to someone with dwarfism. Many people who have the condition prefer the term “little person” or “person of short stature.” For some, “dwarf” is acceptable. For most, “midget” definitely is not.

But here’s an idea everyone can agree on: Why not simply call a person with dwarfism by his or her name?

Being of short stature is only one of the characteristics that make a little person who he or she is. If you’re the parent or loved one of a little person, you know this to be true.

Dwarfism Facts

Here are some facts that other people may not realize about dwarfism and those who have it.

Dwarfism:

• is characterized by short stature. Technically, that means an adult height of 4 feet 10 inches or under, according to the advocacy group Little People of America (LPA).
• can be caused by any one of more than 300 conditions, most of which are genetic. The most common type is called achondroplasia.
• can and most often does happen in families where both parents are of average height. In fact, 4 out of 5 of children with achondroplasia are born to average-size parents.

Dwarfism isn’t:

• an intellectual disability. A person who has dwarfism is typically of normal intelligence.
• a disease that requires a “cure.” Most people with one of these conditions live long, fulfilling lives.
• a reason to assume someone is incapable. Little people go to school, go to work, drive cars, marry, and raise children, just like their average-size peers.

What Causes Short Stature?

More than 300 well-described conditions are known to cause short stature in a child. Most are caused by a spontaneous genetic change (mutation) in the egg or sperm cells prior to conception. Others are caused by genetic changes inherited from one or both parents.

Depending on the type of condition causing the short stature, it is possible for two average-size parents to have a child with short stature, and is also possible for parents who are little people to have an average-size child.

What prompts a gene to mutate is not yet clearly understood. The change is seemingly random and unpreventable, and can happen in any pregnancy. If parents have some form of dwarfism themselves, the odds are likely that their children will also be little people. A genetic counselor can help determine the likelihood of passing on the condition in these cases.

Dwarfism has other causes, including metabolic or hormonal disorders in infancy or childhood. Chromosomal abnormalities, pituitary gland disorders (which influence growth and metabolism), absorptive problems (when the body can’t absorb nutrients adequately), and kidney disease can all lead to short stature if a child fails to grow at a normal rate.

Types of Short Stature

Most types of dwarfism are known as skeletal dysplasia, which are conditions of abnormal bone growth. They’re divided into two types: short-trunk and short-limb dwarfism. People with short-trunk dwarfism have a shortened trunk with more average-sized limbs, whereas those with short-limb dwarfism have an average-sized trunk but shortened arms and legs.

By far, the most common skeletal dysplasia is achondroplasia, a short-limb dwarfism that happens in about 1 of every 15,000 to 40,000 babies born of all races and ethnicities. It can be caused by a spontaneous mutation in a gene called FGFR3, or a child can inherit a change in this gene from a parent who also has achondroplasia.

People with achondroplasia have a relatively long trunk and shortened upper parts of their arms and legs. They may share other features as well, such as a larger head with a prominent forehead, a flattened bridge of the nose, shortened hands and fingers, and reduced muscle tone. The average adult height for someone with achondroplasia is a little over 4 feet.

Diastrophic dysplasia is a different form of short-limb dwarfism. It happens in about 1 in 100,000 births, and is also sometimes associated with cleft palate, clubfeet, and ears with a cauliflower-like appearance. People who have this diagnosis tend to have shortened forearms and calves (this is known as mesomelic shortening).

Spondyloepiphyseal dysplasias (SED) refers to a group of various short-trunk skeletal conditions. Along with achondroplasia and diastrophic dysplasia, it is one of the more common types of dwarfism. In one type of SED, the lack of growth in the trunk area may not become apparent until the child is school age; other forms are apparent at birth. Kids with this disorder also might have clubfeet, cleft palate, and vision and/or hearing issues.

In general, dwarfism caused by skeletal dysplasias results in what is known as disproportionate short stature — meaning the limbs and the trunk are not of the same proportion as those of typically-statured people.

Metabolic or hormonal disorders typically cause proportionate dwarfism, meaning a person’s arms, legs, and trunk are all shortened but remain in proportion to overall body size.

Diagnosis

Some types of dwarfism can be identified through prenatal testing if a doctor suspects a particular condition and tests for it.

But most cases are not identified until after the child is born. In those instances, the doctor makes a diagnosis based on the baby’s appearance, growth pattern, and X-rays of the bones. Depending on the type of dwarfism the child has, diagnosis often can be made almost immediately after birth.

Once a diagnosis is made, there is no “treatment” for most of the conditions that lead to short stature. Hormonal or metabolic problems may be treated with hormone injections or special diets to increase a child’s growth, but skeletal dysplasias cannot be “cured.”

People with skeletal dysplasias can, however, get medical care for some of the health complications associated with their short stature.

Some forms of dwarfism also involve issues in other body systems — such as vision or hearing — and require careful monitoring.

Possible Complications and Treatments

Short stature is the one quality all people with dwarfism have in common. After that, each of the many conditions that cause dwarfism has its own set of characteristics and possible complications.

Fortunately, many of these complications are treatable, so that people of short stature can lead healthy, active lives.

For example, a small percentage of babies with achondroplasia may have hydrocephalus (excess fluid around the brain). They may also have a greater risk of developing apnea (a temporary stop in breathing during sleep). This can be due to abnormally small bone anatomy or because of airway obstruction by the adenoids or the tonsils. Occasionally, a part of the brain or spinal cord is compressed. With close monitoring by doctors, however, these potentially serious problems can be detected early and surgically corrected.

As a child with dwarfism grows, other issues also may become apparent, including:

• development of some motor skills, such as sitting up and walking happening at older ages than an average-sized child
• a greater susceptibility to ear infections and hearing loss
• breathing problems caused by small chests
• weight problems
• curvature of the spine (scoliosis, kyphosis, and/or lordosis)
• bowed legs
• trouble with joint flexibility and early arthritis
• lower back pain or leg numbness
• crowding of teeth

Not every type of dwarfism has all of these problems associated with it, and proper medical care can help with many of them. Surgery also can be used to improve some of the leg, hip, and spine problems people with dwarfism sometimes face.

Nonsurgical options can help, too — for instance, excessive weight can worsen many orthopedic problems, so a dietitian might help develop a healthy plan for shedding extra pounds. And doctors or physical therapists can recommend ways to increase physical activity without putting extra stress on the bones and joints.

Helping Your Child

Although types of dwarfism, and their severity and complications, vary from person to person, in general a child’s life span is not affected by dwarfism. Although the Americans with Disabilities Act protects the rights of people with dwarfism, many members of the short-statured community don’t feel that they have a disability.

You can help your child with dwarfism lead the best life possible by building his or her sense of independence and self-esteem right from the start.

Here are some general tips to keep in mind:

• Treat your child according to his or her age and developmental level, and not size. For example, a 2-year-old should not still be using a bottle, even if he or she is the size of a 1-year-old. And, if you expect a 6-year-old to clean up his or her room, don’t make an exception simply because your child is small.
• Adapt to your child’s limitations. Something as simple as a light switch extender and a well-placed step stool can give a short-statured child a sense of independence around the house.
• Present your child’s condition — both to your child and to others — as a difference rather than a hindrance. Your attitude and expectations can have a significant influence on your child’s self-esteem.
• Learn to outwardly deal with people’s reactions, whether it’s simple curiosity or outright ignorance, without anger. Address questions or comments as directly as possible, then take a moment to point out something special about your child. If your child is with you, this approach shows that you notice all the other qualities that make him or her unique and, importantly, that his or her dwarfism doesn’t cause you any anger. It also helps prepare your child for dealing with these situations when you’re not there.
• If your child is teased at school, don’t overlook it. Talk to teachers and administrators to make sure your child is getting the support he or she needs.
• Encourage your child to find a hobby or activity to enjoy. If sports aren’t going to be your child’s thing, then maybe music, art, computers, writing, or photography will be.
• Finally, get involved with support associations like the Little People of America. Getting to know other people with dwarfism — both as peers and mentors — can show your child just how much he or she can achieve.

Most kids steadily gain weight and grow quickly within the first few years of life. But in some cases, kids don’t meet these expected standards of growth. When this happens, it’s called “failure to thrive.”

Doctors say children “fail to thrive” when they don’t gain weight as expected. Often, these kids also have poor linear (height) growth.

Many things can cause failure to thrive, including illnesses and eating problems. Once doctors find the cause of the problem, they can work with families to help get a child back into a healthy growth pattern.

About Failure to Thrive

Although it’s been recognized for more than a century, failure to thrive lacks a clear definition, in part because it’s not a disease or disorder itself. Rather, it’s a sign that a child is undernourished. In general, kids who fail to thrive don’t receive or cannot take in, keep, or use the calories that would help them grow and gain enough weight.

Doctors usually diagnose the condition in infants and toddlers — an important time of physical and mental development. After birth, a child’s brain grows as much in the first year as it will grow for the rest of a child’s life. Poor nutrition during this period may have lasting harmful effects on brain development.

Most babies double their birth weight by 4 months and triple it by age 1, but kids who fail to thrive usually don’t meet those milestones. Sometimes, a child who starts out “plump” and seems to be growing well may gain less weight later. After a while, height growth may slow as well.

If the condition continues, undernourished kids might:

• lose interest in their surroundings
• avoid eye contact
• become fussy
• not reach developmental milestones like sitting up, walking, and talking at the usual age

Causes

A number of things can cause failure to thrive, including:

• Not enough food offered. In some cases, parents mistakenly cause the problem. Sometimes a parent measures formula incorrectly, causing an infant to get too few calories. Problems with breastfeeding or transitioning to solids also can cause failure to thrive. Parents who worry their child will get fat may restrict the amount of calories they give their infants. And sometimes parents don’t pay enough attention to their children’s hunger cues or can’t afford enough food for their children.
• The child eats too little. Some children have trouble eating enough food because of prematurity, developmental delays, or conditions like autism in which they do not like eating foods of certain textures or tastes.
• Health problems involving the digestive system. Several health conditions can prevent a child from gaining weight. These include gastroesophageal reflux (GER), chronic diarrhea, cystic fibrosis, chronic liver disease, and celiac disease.

  With reflux, the esophagus may become so irritated that a child refuses to eat because it hurts. Persistent diarrhea can make it hard for the body to hold on to the nutrients and calories from food. Cystic fibrosis, chronic liver disease, and celiac disease all cause problems with the body’s ability to absorb nutrients. The child may eat a lot, but the body doesn’t absorb and retain enough of that food. Kids with celiac disease are allergic to gluten, a protein found in wheat and other grains. The immune system’s abnormal response to this protein damages the lining of the intestine so it can’t absorb nutrients properly.

• Food intolerance. A food intolerance, which is different from a food allergy, means the body is sensitive to certain foods. For example, milk protein intolerance means the body can’t absorb foods that have milk proteins, such as yogurt and cheese, which could lead to failure to thrive.
• An ongoing illness or disorder. A child who has trouble eating — because of prematurity or a cleft lip or palate, for example — may not take in enough calories to support normal growth. Other conditions involving the heart, lungs, or endocrine system can increase the amount of calories a child needs and make it hard for the child to eat enough to keep up.
• Infections. Parasites, urinary tract infections (UTIs), tuberculosis, and other infections can force the body to use nutrients rapidly and decrease appetite. This can lead to short- or long-term failure to thrive.
• Metabolic disorders. Metabolic disorders are health conditions that make it hard for the body to break down, process, or take energy from food. They also can cause a child to eat poorly or vomit.

Sometimes a mix of medical problems and environmental factors leads to failure to thrive. For instance, if a baby has severe GER and is reluctant to eat, feeding times can be stressful. The baby may become upset and frustrated, and the caregiver might be unable to feed the child enough food.

Other times, doctors aren’t sure exactly what causes the problem.

Diagnosis

Many babies go through brief periods when their weight gain levels out, or they even lose a little weight. This is not unusual. However, if a baby doesn’t gain weight for 3 months in a row during the first year of life, doctors usually become concerned.

Doctors use standard growth charts to plot weight, length, and head circumference, which are measured at each well-child exam. Children may have failure to thrive if they fall below a certain weight range for their age or fail to gain weight at the expected rate.

To see if there’s a problem, doctors will ask for a child’s detailed health history, including a feeding history. This helps doctors see whether underfeeding, household stresses, or feeding problems might be to blame. A nutritionist or other health care professional also may track the calories in a child’s diet to make sure the child is getting enough.

Doctors might order tests (such as a complete blood count or urine test) to check for underlying medical problems. If a particular disease or disorder is suspected, the doctor might order other tests to check for that condition.

Treatment

Treatment for kids who fail to thrive involves making sure that the child gets the calories needed to grow and addressing any underlying feeding issues. This often requires the help of a care team that may include:

• the primary care doctor or pediatrician
• a registered dietitian to evaluate the child’s dietary needs
• occupational therapists to help caregivers and the child develop successful feeding behaviors
• speech therapists to address any sucking or swallowing problems
• a social worker if a family has trouble getting enough food for the child
• psychologists and other mental health professionals if there are any behavioral issues
• specialists (such as a cardiologist, neurologist, or gastroenterologist) to treat underlying health conditions

Usually, kids who have failure to thrive can be treated at home along with regular doctor visits. The doctor will recommend high-calorie foods and may place an infant on a high-calorie formula. Depending on the child’s feeding habits, doctors may recommend offering foods of certain textures, spacing out meals to make sure children are hungry, avoiding “empty” calories like juices and candies, and other strategies depending on the child’s condition and family situation.

In cases of severe failure to thrive, a child who is not growing with initial treatment may need tube feedings. In tube feedings, a tube is put in that runs from the nose into the stomach. Liquid nutrition is provided at a steady rate through the tube and is usually given at nighttime only. The child can continue with daily activities and eat freely during the day. Once he or she starts getting more calories, the child will feel better and will probably start to eat more on his or her own. At that point, the tube can be removed.

Children with extreme failure to thrive might need to be treated in a hospital. There, they will be fed and monitored around the clock for 10 to 14 days (or longer), until they gain some weight. After that, it still can take months until the symptoms of severe malnutrition are gone.

How long treatment lasts can vary. Weight gain takes time, so it might be several months before a child is back in the normal range. When the condition is due to a chronic illness or disorder, kids may have to be monitored regularly at their doctor’s office. In those cases, treatment may take even longer, perhaps for a lifetime.

Does My Child Have Failure to Thrive?

If you’re worried that your child is failing to thrive, remember that many things can cause slower weight gain. For instance, breastfed babies and bottle-fed babies often gain weight at different rates in the early newborn period.

Genetics also play a big role in weight gain. So if a baby’s parents are slim, the baby may not put on pounds quickly. However, infants should still gain weight steadily. As a general guideline, babies usually eat often in a 24-hour period and should gain about 1 ounce a day in the first month of life. It can be hard to judge this from home (even if you have a scale), so it’s important to see your child’s doctor regularly. Doctors can check for problems at regular well-child checkups, so it’s important to keep these appointments.

When to Call the Doctor

If you notice a drop in weight gain or your baby doesn’t seem to have a normal appetite, call your doctor. Also call about any major change in eating patterns. Toddlers and older kids may have days and sometimes weeks when they show little interest in eating, but that shouldn’t happen in infants.

If you have trouble feeding your baby, your doctor can help. When a child doesn’t readily eat, parents can become frustrated and feel they’re doing something wrong. That can make the problem worse, causing stress for you and your baby. Instead, get help for both of you by talking to your doctor.

Your 8-year-old son wakes up crying in the night complaining that his legs are throbbing. You rub them and soothe him as much as you can, but you’re uncertain about whether to give him any medicine or take him to the doctor.

Sound familiar? Your son is probably having growing pains, which about 25% to 40% of kids do. They usually strike during two periods: in early childhood among 3- to 5-year-olds and, later, in 8- to 12-year-olds.

Signs and Symptoms

Growing pains always concentrate in the muscles, rather than the joints. Most kids report pains in the front of their thighs, in the calves, or behind the knees. Joints affected by more serious diseases are swollen, red, tender, or warm — the joints of kids having growing pains look normal.

Although growing pains often strike in late afternoon or early evening before bed, pain can sometimes wake a sleeping child. The intensity of the pain varies from child to child, and most kids don’t have the pains every day.

What Causes Them?

Bone growth hasn’t been proved to cause pain. So “growing” pains might just be aches and discomfort from the jumping, climbing, and running that active kids do during the day. The pains can happen after a child has had a particularly athletic day.

Diagnosing Growing Pains

One symptom that doctors find most helpful in making a diagnosis of growing pains is how a child responds to touch while in pain. Kids who have pain from a serious medical cause don’t like to be handled because movement can make the pain worse. But those with growing pains respond differently — they feel better when they’re held, massaged, and cuddled.

Growing pains are what doctors call a diagnosis of exclusion. This means that other conditions will be ruled out before a diagnosis of growing pains is made. This usually is done by taking a medical history and doing a physical exam. In rare cases, blood tests and X-rays might be done before a doctor diagnoses growing pains.

Helping Your Child

Things that may help ease growing pains include:

• massaging the area
• stretching
• placing a heating pad on the area
• giving ibuprofen or acetaminophen
  Do not give aspirin to a child or teen, as it has been linked to a rare but serious illness called Reye syndrome.

When to Call the Doctor

Call your doctor if any of these symptoms happen with your child’s pain:

• long-lasting pain, pain in the morning, or swelling or redness in one particular area or joint
• pain associated with an injury
• fever
• limping
• unusual rashes
• loss of appetite
• weakness
• tiredness
• unusual behavior

These signs are not related to growing pains and should be checked out by the doctor.

While growing pains aren’t usually related to illness, they can upset kids — and parents. Because the aches are usually gone in the morning, parents sometimes think that a child faked the pains. But this usually isn’t true. Instead, offer support and reassurance that growing pains will pass as kids grow up.

About Growth Charts

Look at any class picture, and you’ll see kids of the same age in all shapes and sizes. Some kids look tiny next to their peers, while others literally stand head and shoulders above their classmates.

As easy as it is to make these comparisons and to draw conclusions about what you see, the reality is that kids grow at their own pace. Big, small, tall, short — there is a wide range of healthy shapes and sizes among children.

Genetics, gender, nutrition, physical activity, health problems, environment, hormones, and lifestyle factors like nutrition and physical activity all influence a child’s height and weight. And many of these factors can vary widely from family to family.

So how does a doctor figure out whether a child’s height and weight measurements are “normal”? Whether he or she is developing on track? Whether any health problems are affecting growth?

A doctor uses growth charts to help answer those questions. Here are some facts about growth charts and what they say about a child’s health.

Why Do Doctors Use Growth Charts?

Growth charts are a standard part of any checkup, and they show health care providers how kids are growing compared with other kids of the same age and gender. They also allow doctors and nurses to see the pattern of kids’ height and weight gain over time, and whether they’re developing proportionately.

Let’s say a child was growing along the same pattern until he was 2 years old, then suddenly started growing at a much slower rate than other kids. That might indicate a health problem. Doctors could see that by looking at a growth chart.

Does a Different Pattern Indicate a Problem?

Not necessarily. The doctor will interpret the growth charts in the context of the child’s overall well-being, environment, and genetic background. Is the child meeting other developmental milestones? Are there other signs that a child is not healthy? How tall or heavy are the child’s parents and siblings? Was the child born prematurely? Has the child started puberty earlier or later than average? These are all factors that the doctor will use to help understand the numbers on the growth chart.

Are All Kids Measured on One Growth Chart?

No. Girls and boys are measured on different growth charts because they grow in different patterns and at different rates.

And one set of charts is used for babies, from birth to 36 months. Another set of charts is used for kids ages 2 to 20 years old. Also, special growth charts are used for children with certain conditions, such as Down syndrome.

Commonly used standard growth charts include:

Ages birth to 36 months (3 years):
Boys’ length- and weight-for-age
Girls’ length- and weight-for-age
Girls’ head circumference-for-age and weight-for-length
Boys’ head circumference-for-age and weight-for-length

Ages 2 to 20 years:
Girls’ stature- and weight-for-age
Boys’ stature- and weight-for-age
Girls ‘ weight-for-stature (height)
Boys’ weight-for-stature (height)

What Measurements Are Put on the Charts?

Up until the time babies are 36 months old, doctors measure weight, length, and head circumference.

With older kids, doctors measure weight, height, and body mass index (BMI). It’s important to look at and compare weight and height measurements to get a full picture of a child’s growth.

Why Is Head Circumference Measured?

In babies, head circumference (the distance around the largest part of the head) can provide clues about brain development. If a baby’s head is bigger or smaller than most other kids’ or the head circumference stops increasing or increases quickly, it may indicate a problem.

For example, an unusually large head may be a sign of hydrocephalus, a buildup of fluid inside the brain. A head that’s smaller than average may be a sign that the brain is not developing properly or has stopped growing.

What Are Percentiles?

Percentiles are measurements that show where a child is compared with others. On the growth charts, the percentiles are shown as lines drawn in curved patterns.

When doctors plot a child’s weight and height on the chart, they see which percentile line those measurements land on. The higher the percentile number, the bigger a child is compared with other kids of the same age and gender, whether it’s for height or weight; the lower the percentile number, the smaller the child is. For example, if a 4-year-old boy’s weight is in the 10th percentile, that means that 10% of boys that age weigh less than he does and 90% of 4-year-old boys weigh more.

How Are Percentiles Determined?

The Centers for Disease Control and Prevention (CDC) created the growth charts that are most commonly used in the United States. They were last updated in 2000. After collecting growth measurements from thousands of U.S. children over a period of time, the CDC was able to show the range of these measurements on one chart, using percentile curves.

Being in a high or a low percentile does not necessarily mean that a child is healthier or has a growth or weight problem. Let’s say that 4-year-old boy, who is in the 10th percentile for weight, is also in the 10th percentile for height. So 10% of kids are shorter and weigh less than he does, and most kids — 90% — are taller and weigh more. That just means that he’s smaller than average, which usually doesn’t mean there is a problem. If his parents and siblings are also smaller than average, and there are other signs that he’s healthy and developing well, doctors would likely conclude that there’s no cause for concern.

What’s the Ideal Percentile for My Child?

There is no one ideal number. Healthy children come in all shapes and sizes, and a baby who is in the 5th percentile can be just as healthy as a baby who is in the 95th percentile.

Ideally, each child will follow along the same growth pattern over time, growing in height and gaining weight at the same rate, with the height and weight in proportion to one another. This means that usually a child stays on a certain percentile line on the growth curve. So if our 4-year-old boy on the 10th percentile line has always been on that line, he is continuing to grow along his pattern, which is a good sign.

What Could Signal a Problem?

A few different growth chart patterns might signal a health problem, such as:

• When a child’s weight or height percentile changes from a certain pattern it’s been following. For example: If height and weight consistently are on the 60th percentile line until a child is 5 years old, then the height has dropped to the 30th percentile at age 6, that might indicate that there’s a growth problem because the child is not following his or her previous growth pattern. Many kids may show changes in growth percentiles at certain points in development, when it’s normal for growth rates to vary more from child to child. This is particularly common during infancy and puberty.
• When kids don’t get taller at the same rate at which they’re gaining weight. Let’s say a boy’s height is in the 40th percentile and his weight is in the 85th percentile. (So he’s taller than 40% of kids his age, but weighs more than 85% of kids his age.) That might be a problem. On the other hand, if he’s in the 85th percentile for height and weight and follows that pattern consistently over time, that usually means that he’s a normal child who’s just larger than average.

If you have any questions about your child’s growth — or growth charts — talk with your doctor.

You’re in for many changes! By midway through this year, most babies are walking and learning to talk. They’re turning into toddlers. By their second birthdays, most are losing that “baby” look. As toddlers get stronger and more capable, their rate of physical growth slows during this year.

How Much Should My Child Grow?

During this second year of life, growth slows down. Your toddler may gain about 5 pounds (2.27 kg) and grow about 4 or 5 inches (10 to 12 cm). By 2 years, children have reached about half of their adult height and 90% of adult head size. Boys tend to weigh about a pound more than girls but average about the same height.

What you will notice more than actual growth are changes in a toddler’s appearance. Body proportions are beginning to change. Instead of sporting the rounded belly and relatively short arms and legs suited to crawling on all fours, toddlers start to trim down, become more muscular because of increased activity, and will begin to look more like preschoolers than babies.

Should I Be Concerned?

Like babies, toddlers come in all shapes and sizes. Your doctor will continue to plot your little one’s growth on a growth chart during regular checkups. Although you may be concerned that your child is too thin or too chubby at any one time, the most important thing is that your child continues to grow at a steady rate.

During the second year of life, babies are learning to feed themselves. They are moving to table foods and learning about new tastes and textures. Keep in mind that appetites slow down as growth slows and there may be times when your child is not very interested in food. If you have concerns your child is not eating enough, speak with your doctor.

Encourage activity and exploration by providing a safe environment that lets your child be active every day. Besides the physical benefits, this is also how a lot of learning takes place. This should be fairly easy, as most toddlers are naturally curious and seize every opportunity to move.

Try not to let your baby spend too much time in confined spaces — such as strollers, playpens, and cribs — that restrain moving and exploring.

What’s Next?

Toddlers grow at a slower but steady rate. From their second birthday to their third, most kids grow only about 2-3 inches. But you will see your child growing in other ways, especially in the area of language.

Continue to provide a safe and healthy environment to support your child’s growth and development. Talk to your doctor if you have any concerns about your child’s growth.

Teens going through puberty will have many changes in their developing bodies as growth surges and muscles change shape.

There’s a very broad range of time in which kids hit puberty-related growth spurts:

• Most girls start their sexual development between the ages of 8 and 13 (the average age is 12), and have a growth spurt between the ages of 10 and 14.
• Most boys start developing sexually between the ages of 10 and 13, and continue to grow until they’re around 16.

Growth and Changes During Puberty

Puberty — or sexual development — is a time of dramatic change for both boys and girls. Hormone-driven changes are accompanied by growth spurts that transform kids into physically mature teens as their bodies develop.

It’s important for them to have healthy eating habits, a well-balanced diet, and some physical activity each day to ensure continued growth and proper development during these years.

Changes in Girls

These characteristics describe the sequence of events in girls as they go through puberty:

• Breasts begin to develop and hips become rounded.
• An increased rate of growth in height begins.
• Pubic hair begins to appear, usually within 6 to 12 months after the start of breast development.
• The uterus and vagina, as well as labia and clitoris, increase in size.
• Pubic hair is well established and breasts grow further.
• The rate of growth in height reaches its peak about 2 years after the start of puberty.
• Menstruation begins, almost always after the peak growth rate in height (average age is 12.5 years).

Once girls start to menstruate, they usually grow about 1 or 2 more inches, reaching their final adult height by about age 14 or 15 years (younger or older depending on when puberty began).

Changes in Boys

Boys tend to show the first physical changes of puberty between the ages of 10 and 16. They tend to grow most quickly between ages 12 and 15. The growth spurt of boys is, on average, about 2 years later than that of girls. By age 16, most boys have stopped growing, but their muscles will continue to develop.

Other features of puberty in boys include:

• The penis and testicles increase in size.
• Pubic hair appears, followed by underarm and facial hair.
• The voice deepens and may sometimes crack or break.
• The Adam’s apple, or larynx cartilage, gets bigger.
• Testicles begin to produce sperm.

At the Doctor’s Office

Normal growth — supported by good nutrition, enough sleep, and regular exercise — is one of the best overall indicators of your teen’s good health.

Despite data collected for growth charts, “normal” heights and weights are difficult to define. Your teen’s growth pattern is largely determined by genetics. Shorter parents, for instance, tend to have shorter kids, whereas taller parents tend to have taller kids.

Although you may worry if your child isn’t as tall as other classmates, the more important question is whether your child is continuing to grow at a normal rate. If your doctor detects a problem — such as a growth rate that had been normal but has recently flattened — he or she may track your child’s measurements carefully over several months to see whether the growth pattern suggests a possible health problem or is just a variation of normal.

It’s not unusual for teens to have their own concerns about how they’re growing and how they look. Girls can be very critical of their own weight, which can sometimes lead to unhealthy body image concerns and dieting practices. Boys tend to be more concerned with their height and muscle development, which can also lead to unhealthy practices, like using steroids and protein supplements.

If you’re concerned about your teen’s body image, or eating and exercise habits, the doctor’s office is a good place to discuss this. Many teens worry a lot about being different from their peers and about anything that would make them not fit in or seem “normal.”

Encourage your teen to bring up any of these concerns with the doctor, if he or she feels comfortable doing so. The doctor can provide reassurance that other kids have the same concerns about their size.

If you have any other concerns about your teen’s growth or development, talk with your doctor.

During the third year of life, most toddlers gain about 4 pounds (1.8 kilograms) and grow about 2 to 3 inches (5 to 8 centimeters).

They’re extremely active and mobile, and learning in very physical ways. They’re running around and exploring their world, and picking up new skills, like kicking a ball and riding a tricycle.

Your toddler’s appetite may vary greatly now, which is common. It is also common for some toddlers to get stuck on one food. Food “jags” usually don’t last long if you don’t give in to them. To build healthy eating habits, keep serving a variety of nutritious foods and let your child decide which and how much of them to eat.

Although kids come in all shapes and sizes, a healthy toddler should continue to grow at a regular pace. The doctor will measure and weigh your child at routine checkups and plot the results on a growth chart. This lets the doctor track your child’s growth over time and spot any trends that need attention.

Helping Kids Grow

Normal growth — supported by good nutrition, plenty of sleep, and regular exercise — is one of the best overall indicators of a child’s good health. But your child’s growth pattern is largely determined by genetics. Pushing kids to eat extra food or greater than recommended amounts of vitamins, minerals, or other nutrients will not increase their height.

Malnutrition severe enough to affect growth rate is uncommon today in the United States and other developed countries unless a child also has a related chronic illness or disorder.

At the Doctor’s Office

Despite data collected for growth charts, “normal” heights and weights are difficult to define. Shorter parents, for instance, tend to have shorter kids, whereas taller parents tend to have taller kids.

Although you may worry if your child isn’t as tall as his or her peers or weighs more, the more important question is whether your child is continuing to grow at a normal rate. If, for instance, your child’s growth rate had been normal but has recently slowed, the doctor may track your child’s measurements over a few months to see whether this is a possible health problem or just a variation of normal.

Most kids who are growing at or below the 5th percentile line on the growth chart are usually following one of these two normal variant growth patterns:

1. Familial (genetic) short stature. These kids have inherited genes for short stature from their parents. Usually one or both parents, and often other relatives, are short. Although they are shorter than average, they grow at a normal rate and are otherwise healthy, showing no symptoms of medical problems that can affect growth. They generally enter puberty at an average age and reach a final adult height similar to that of their parents. In general, no treatment is recommended or known to be effective in significantly increasing their final adult height.
2. Constitutional growth delay (delayed puberty). Although they are usually of average size in early infancy, these kids undergo a period of slower-than-average growth between 6 months and 2 years of age, causing them to fall lower on the growth chart. After about age 2 or 3 years, kids with constitutional growth delay will grow at a normal childhood rate until they reach puberty and undergo a growth spurt at a later age than most other teens. Because they start puberty later, they will continue to grow after most teens have stopped, thus “catching up” to their peers in final adult height. Usually, there’s a family history of this kind of growth pattern, and in general, there’s no need for treatment.

If your child is growing too slowly, your doctor might order tests to determine whether this is related to a medical or genetic condition that would interfere with growth.

Be sure to discuss any concerns you have about your child’s growth or development with your doctor.

Kids at this age are still very physical, but they learn in a more focused and less hectic way than when they were younger. These kids typically gain about 4-5 pounds (2 kilograms) and grow about 2-3 inches (5 to 8 centimeters) per year. An average 4-year-old weighs about 40 pounds and is about 40 inches tall.

Preschoolers are still developing and refining their gross motor skills (using their arms and legs to move and play), as well as their fine motor skills (working on arts and crafts and puzzles). By this age, kids can usually hop on one foot and are learning to skip.

Play becomes increasingly imaginative and is an important part of kids’ growth and development now. So it’s important to make sure they have time for creative play — alone and with friends — whether that means drawing pictures, playing house, or acting a part.

Although kids come in all shapes and sizes, a healthy child should continue to grow at a regular pace. To monitor physical development, the doctor will weigh and measure your child at regular checkups, then plot the results on a standard growth chart to follow over time and compare with that of other kids the same age and gender.

Helping Your Child Grow

Normal growth — aided by good nutrition, plenty of sleep, and regular exercise — is one of the best overall indicators of a child’s good health. But your child’s growth pattern is largely determined by genetics. Pushing kids to eat extra food or more than the recommended amounts of vitamins, minerals, or other nutrients will not make them taller. And eating too much may lead to excessive weight gain.

Preschoolers can be picky eaters, but it’s important to continue to offer a variety of foods. In addition to good nutrition, preschoolers should get at least 60 minutes of physical activity each day. Kids at this age are naturally active, so encourage that activity and provide a safe environment for exploration.

At the Doctor’s Office

There is a wide range of “normal” heights and weights. Shorter parents, for instance, tend to have shorter kids, whereas taller parents tend to have taller kids.

Although you may worry if your child isn’t as tall as his or her peers, the more important question is whether your child is continuing to grow at a normal rate. If, for instance, your child’s growth rate had been normal but has recently slowed, the doctor may track your child’s measurements over a few months to see whether this is a possible health problem or just a variation of normal.

You may be concerned that your child is too small. Most kids who are very short — at or below the 5th percentile on the growth chart — are usually following one of two normal variant growth patterns:

1. The first is familial (genetic) short stature, in which kids have inherited genes for short stature but will grow at a normal rate, enter puberty at an average age, and reach a final adult height similar to that of their parents.
2. The second is constitutional growth delay, in which kids grow at a normal rate but are smaller than their peers, enter puberty later, and continue growing after their peers have stopped, thus usually reaching a normal adult height.

However, medical conditions like hypothyroidism also can affect a child’s growth, so talk with your doctor if you have a concern.