Growth & Your Baby

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.

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.

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.

My baby is 8 months old and already likes to stand with assistance. Is now the right time to get him used to wearing shoes?
– Maria

It’s exciting to see your baby getting ready for his first steps, but hold off on that first pair of tiny shoes until he is walking. Shoes are mainly for protecting a baby’s feet, especially when walking outdoors. Putting shoes on sooner won’t help your baby learn to walk any faster or better. In fact, shoes that have hard, inflexible soles can actually make it harder for him to learn to walk because they restrict natural foot movement.

For now, barefoot is still best for your baby’s foot development. A pair of socks or booties with non-skid soles is also fine for chilly toes. Once your baby starts walking, choose shoes that:

• are lightweight and flexible (remember to avoid hard, stiff shoes that restrict foot movement)
• fit well (aren’t too loose or too tight)
• have non-skid soles

As your baby grows into an off-and-running toddler, you might need to choose shoes that rise above the ankle to keep them from slipping off his little piggies.

Your baby develops from head to toe — and in that order. That’s why babies can hold their heads up before they learn to walk, and can push up on their elbows before pushing up with their hands. Keeping this in mind can help you predict what your baby’s next big developmental step will be.

Doctors use certain milestones to tell if a baby is developing as expected. There’s a wide range of what’s considered normal, so some babies gain skills earlier or later than others. Babies who were born prematurely reach milestones later. Always talk with your doctor about your baby’s progress.

Here are some new skills your baby may have this month:

Communication and Language Skills

• develops more distinct cries to indicate hunger, pain, or tiredness
• gurgles and coos (says “ooh” and “ah”)
• smiles in response to being talked to, played with, or smiled at
• turns his or her attention to whoever is speaking

Movement and Physical Development

• when on his or her belly, can hold up the head and may even push up on the arms
• good head control when held in a sitting position
• newborn reflexes start to go away, like the moro (startle) reflex and tonic reflex (fencer’s pose)
• fists remain unclenched half of the time

Social and Emotional Development

• comforts himself or herself, maybe by putting a fist in the mouth
• makes an effort to look at parents when they’re nearby
• smiles when happy

Cognitive Skills (Thinking and Learning)

• gets bored and lets you know it by fussing or crying when a change of scenery or a new activity is needed
• is alert to sounds
• focuses on and tracks faces and objects from side to side

When to Talk to Your Doctor

As a parent, you are the best observer of your baby. Share your concerns — even little ones — with your baby’s doctor. Tell the doctor if your baby:

• doesn’t notice or play with his or her hands
• has one eye that is crossed or eyes that don’t line up in the same direction
• has legs or hands that do not move in unison: only one leg kicks, for example, or one arm shakes

If you ever notice that your baby has lost skills he or she once had or shows weakness on one side of the body, tell your doctor.

Notice your baby doing anything new? Big strides in development are happening this month. That’s because the left side of the brain is now “talking” to the right side of the brain. This means your baby may begin to rock back and forth to prepare for crawling by moving the arms and legs in sync, or pass a toy from one hand to the other (who knew it was such a feat!?).

Doctors use certain milestones to tell if a baby is developing as expected. There’s a wide range of what’s considered normal, so some children gain skills earlier or later than others. Babies who were born prematurely reach milestones later. Always talk with your doctor about your baby’s progress.

Here are some things your baby might be doing:

Communication and Language Skills

• blows raspberries and begin to pronounce consonants like “ba,” “da,” and “ga”
• starts to babble (“babababa”)
• begins to recognize his or her own name
• understands a few words, such as “bath”
• uses his or her voice to get attention and express feelings

Movement and Physical Development

• begins to push up to a crawling position, and possibly rock back and forth on the knees
• sits with support
• stands with help and, from a standing position, bounces up and down with support
• passes an object from one hand to the other
• newborn reflexes (like the grasp reflex) go away
• reaches for and grabs objects using a raking grasp (using the fingers to rake at and pick up objects)
• rolls over both ways (back to front, front to back)

Social and Emotional Development

• recognizes and responds happily to familiar faces
• startles at loud noises and might cry in fear
• is socially active, smiles to attract your attention, and responds to you when you interact
• expresses happiness, pleasure, sadness, and displeasure (anger)

Cognitive Skills (Thinking and Learning)

• “mouths” toys and other items to get a better understanding of the environment
• reaches for anything (and everything!) in view
• moves in the direction he or she wants to go (for example, when your baby sees you walk into the room, his or her arms go up and your baby leans toward you)
• looks at the floor after dropping a toy, showing he or she understands where it fell

When to Talk to Your Doctor

Every baby develops at his or her own pace, but if you notice anything than concerns you — however small — share it with your doctor. Always tell the doctor if your baby:

• shows little interest in others and rarely smiles or “talks”
• makes little eye contact and rarely points a finger at something
• does not move an object from one hand to the other
• is unable to sit up with support
• has trouble eating purées by spoon (for example, pushes food out of the mouth instead of swallowing)

Also, if you ever notice that your baby has lost skills he or she once had or shows weakness on one side of the body, tell your doctor.

Nine-month-olds have a new understanding of the world. They learn that just because they can’t see mom or dad at a certain time doesn’t mean they don’t exist. So now, your baby may begin to miss you when you’re gone. This can lead to separation anxiety — distress at your departure.

While this might seem like a bad thing, it’s actually very good — and marks an important leap in thinking. Comfort and reassure your baby to help him or her feel loved and secure.

Doctors use certain milestones to tell if a baby is developing as expected. There’s a wide range of what’s considered normal, so some babies gain skills earlier or later than others. Babies who were born prematurely reach milestones later. Always talk with your doctor about your baby’s progress.

Here are some things your baby might be doing:

Communication and Language Skills

• communicates “no” by closing the mouth or turning away when finished eating
• understands the word “no”
• says “mama” and “dada” (but not just to parents)
• can wave goodbye and say “bye-bye”
• starts pointing to objects

Movement and Physical Development

• sits without support, pulls to stand, and walks along furniture (“cruising”)
• starts to grasp small pieces of food (such as pieces of “O”-shaped cereal)
• can hold one item in each hand at the same time

Social and Emotional Development

• might be fearful of strangers
• misses caregivers when they leave
• seeks reassurance from caregivers (a baby starting to crawl, for example, will often “check back” with mom or dad while developing this new skill)
• attaches to “transitional objects” for security, such as stuffed animals or a favorite blanket

Cognitive Skills (Thinking and Learning)

• understands “object permanence,” the idea that an object or person exists somewhere even though the baby can’t see the object or person at that moment (for example, a baby with this understanding will look for a toy that a caregiver hides behind a blanket)
• enjoys interactive games such as “peekaboo” and “so big”
• looks at the pages of a book while you read
• bangs objects on floor or table to create sound

When to Talk to Your Doctor

Every baby develops at his or her own pace, but if you notice anything that concerns you — however small — share it with your doctor. Always tell the doctor if your baby:

• shows no reaction when you leave the room
• cannot roll onto the belly
• hasn’t lost newborn reflexes, such as the startle reflex

Also, if you ever notice that your baby has lost skills he or she once had or shows weakness on one side of the body, tell your doctor.

From the moment babies are born, they begin responding to the world around them. Their reactions — being calmed by a mother’s embrace or startled by a loud sound — are examples of normal infant development.

Doctors use these milestones to tell whether a baby is developing as expected. There’s a wide range of what’s considered normal, so some babies gain skills earlier or later than others. Babies who were born prematurely reach milestones later. Always talk with your doctor about your baby’s progress.

Here’s what your newborn might do:

Communication and Language Skills

• turns his or head head toward a parent’s voice or other sounds
• cries to communicate a need (to be held or fed, to have a diaper changed, or to sleep)
• stops crying when the need is met (your baby is picked up, fed, or changed; or goes to sleep)

Movement and Physical Development

• moves in response to sights and sounds
• rooting reflex: turns toward breast or bottle and sucks when a nipple is placed in the mouth
• Moro reflex (startle response): when startled, throws out arms and legs, then curls them back in
• fencer’s pose (tonic neck reflex): when head is turned to one side, straightens the arm on that side while bending the opposite arm
• grasp reflex: holds a finger placed in the palm; toes curl when touched on the sole of the foot

Social and Emotional Development

• soothed by a parent’s voice and touch
• has periods of alertness

Cognitive Skills (Thinking and Learning)

• looks at faces when quiet and alert
• follows faces

When to Talk to Your Doctor

Every child develops at his or her own pace, but if there’s something that concerns you, tell your doctor. Also, tell the doctor if your baby:

• doesn’t suck well at the breast or on a nipple
• has an arm or leg that seems weaker than the other
• is extremely irritable or difficult to soothe

What Is Growth?

From the moment parents greet their newborn, they watch the baby’s progress eagerly, anticipating every inch of growth and each new developmental milestone along the way. But how can they tell if their child is growing properly?

Physical growth refers to the increases in height and weight and other body changes that happen as a child matures. Hair grows; teeth come in, come out, and come in again; and eventually puberty hits. It’s all part of the growth process.

What’s Normal?

The first year of life is a time of amazing change during which babies, on average, grow 10 inches (25 centimeters) in length and triple their birth weights.

Given all the growth that happens then, new parents might be surprised when their child doesn’t continue to grow so fast after the first year. But no child continues the rate of growth experienced during infancy. After age 1, a baby’s growth in length slows quite a bit. By age 2, growth in height usually continues at a fairly steady rate of about 2½ inches (6 centimeters) per year until adolescence.

No child grows at a perfectly steady rate throughout this period of childhood, though. Weeks or months of slightly slower growth alternate with mini “growth spurts” in most children. Kids actually tend to grow a bit faster in the spring than during other times of the year!

A major growth spurt happens at the time of puberty, usually between 8 to 13 years of age in girls and 10 to 15 years in boys. Puberty lasts about 2 to 5 years. This growth spurt is associated with sexual development, which includes the appearance of pubic and underarm hair, the growth and development of sex organs, and in girls, the start of menstruation.

By the time girls reach age 15 and boys reach age 16 or 17, the growth associated with puberty will have ended for most and they will have reached physical maturity.

At the Doctor’s Office

Beginning in infancy, kids will visit a doctor for regular checkups. During these, the doctor will record height and weight as they compare with that of other kids the same age on a growth chart. This valuable tool can help the doctor determine whether a child is growing at an appropriate rate or whether there might be problems.

What Parents Can Do

You can do a few things to help ensure that your child grows and develops normally. Critical to kids’ overall health and wellness are:

• Enough rest: Sleep patterns vary by age and individual child, but most kids need an average of 10 to 12 hours of sleep per night. Sleep gives growing bodies the rest they need to continue growing properly.
• Good nutrition: A balanced diet full of essential vitamins and minerals will help kids reach their full growth potential.
• Regular exercise: Because obesity is a problem for many kids, parents should make sure that their kids exercise regularly. Bicycling, hiking, in-line skating, sports, or any enjoyable activity that will motivate kids to get moving will promote good health and fitness and help them maintain a healthy weight.

Talking to Kids About Growth

Kids differ in growth and development during childhood — just like adults, some kids are taller or shorter. Generally, girls hit puberty earlier than boys, although some girls might lag behind their peers in breast development or getting their first period. All of this is usually normal.

Try to avoid comparing growth among siblings or other children. Drawing attention to height, for example, will only make kids feel self-conscious about their size. Encourage your kids to accept their own growth and development. Explain that some kids grow and develop at different rates — and late bloomers usually catch up eventually.

Kids have many questions about growth, from why their teeth fall out to difficult or potentially embarrassing topics like breast development or sweating. Answer questions honestly and even initiate conversations about growth to help kids understand the many changes they’re facing. This will help them accept the changes positively.

If you’re uncomfortable discussing these topics, your kids may think that this means there’s something shameful about the changes they go through and might be less likely to bring their concerns to you.

Kids who are short often face teasing by peers and may need help coping. You can help by supporting your child’s self-esteem. For example, although it might be difficult for a small boy to make the football team, focusing on alternatives, such as soccer or tennis, may make him feel better about himself and what he can do. A small teen might have concerns about dating, driving, and participating in sports. It’s important to try to understand your child’s feelings and to keep the lines of communication open.

Another way to boost your child’s mood is to encourage activities that don’t focus on height or weight. Special skills and individual qualities, such as musical talent or a love of literature, are things to be proud of, too.

If You Think There’s a Problem

Some parents worry about their child’s growth and development. So it can be reassuring to know that most kids who are short or delayed in development are healthy and normal. For example, shorter parents tend to have shorter children and not all kids develop at the same rate.

If you have concerns, the first step is to talk with your doctor, who can examine your child, ask questions about your family history and, if necessary, order tests to see if there’s a medical condition affecting growth. The doctor may monitor your child’s growth more often on a growth chart or refer your child to a pediatric endocrinologist (a doctor specializing in growth disorders) for further evaluation.