Growth is a Serious Sign of Children’s Health.
Introduction
Children's growth might seem straightforward, as it's a natural part of their development. However, if you suspect your child is growing too slowly or too quickly for their age, and they have not yet received a diagnosis, this page serves as an excellent starting point to help you understand the facts about children's growth.
It is crucial to thoroughly read the information provided, as disruptions in a child's growth can be early warning signs of various health conditions in their development. These issues can range from simple nutritional or thyroid problems to more serious concerns such as tumors, all of which can first manifest in a child's growth. The marks on the wall tracking your child's growth are more important than you might think!
For a list of medical associations and parent organizations by country, please Click Here. By staying informed and proactive, you can ensure your child's continued growth and overall well-being.
Video: How to Measure Your Child at Home
What is normal growth?
Children's growth, or the rate at which they grow each year, is a critical indicator of their overall health. Normal growth for children between the ages of 2.5 and puberty is at least 2.5 inches (6.35 cm) per year. If your child is not growing at this minimum rate or is growing significantly faster than their peers, it is essential to investigate the possible causes of these growth abnormalities.
The first step is to schedule an appointment with your child's healthcare professional, who can accurately measure your child and assess their position on a growth chart relative to their peers.
Establishing a growth pattern for your child requires a sufficient number of recorded measurements over time. Most specialists require at least 12 months of accurate measurements to determine a pattern. Consistent growth, whether ahead or behind other children their age, is important for pediatric endocrinologists (growth specialists) to assess.
Percentiles are a common method used to determine a child's size and growth pattern in relation to their peers. It is more important to monitor your child's growth over time than to focus on their specific percentile. Any significant changes in your child's percentile, either upward or downward, should be discussed with your pediatrician.
Numerous factors influence children's growth, including their genetic potential, underlying medical conditions, and nutrition. If you are concerned about your child's height or weight, consult with your pediatrician and continue to monitor their growth annually (or more frequently if you observe deviations from a normal pattern).
Underlying conditions can cause growth abnormalities in children, and growth disruptions can serve as early warning signs of potential health issues. These conditions can range from hereditary, genetic, or congenital factors to illnesses, medications, nutrition, hormones, and psychosocial environment. Regular height and weight measurements should be incorporated into both sick visits and well-child check-ups.
Normal height growth rates vary by age, and growth should be closely monitored to identify potential issues. If your child's growth deviates from the expected rate, consult with a healthcare professional to explore possible causes and treatments.
To track your child's growth, maintain records with measurements taken every 3-6 months for infants and yearly for children over 2 years of age. Accurate height measurements can be obtained by having your child stand in bare feet against a wall, and these measurements can be recorded on a growth chart. If your child's growth is significantly outside the typical range or deviates from the established pattern, consult with your pediatrician to determine the appropriate course of action.
What Causes Children to Grow Poorly?
Underlying Conditions of Children’s Growth Abnormalities
It is often said that maintaining a normal growth pattern is a good indicator of a child’s overall good health. Failure to grow at least 2 1/2 inches (6.35 cm) each year can be nature’s early warning sign that something underlying (unseen) is abnormal and needs medical evaluation. Growth is influenced by many factors such as heredity, genetic or congenital, illness and medications, nutrition, hormones, and psycho-social environment. Measurements of growth height and weight – are a very inexpensive service that should be offered by all health care providers rendering care to children. Additionally, it is also important that these be done correctly and included as a part of sick visits as well as “well child” check-ups.
Normal height growth rates vary according to age. Children during the first year of life should grow 7-10 inches (17.78-25.4 cm). During the second year growth slows to an average of 5 inches /per year. During the third year growth averages 3 inches (7.62 cm) /per year. From age 4 years until puberty, growth should be at least 2 inches (5.08 cm)/per year. Pubertal changes prompt a growth spurt of 2 ½ -4 ½ inches (6.35 cm-11.43 cm)/year for girls usually starting by 10 years. However, boys experience both puberty and this growth spurt later – usually starting by 12 years and averaging 3 – 5 inches/year. After pubertal changes are completed and bone ends fuse, no further growth is possible.
1. Heredity: Children are a reflection of their parents’ growth patterns and height.
Parents who were late bloomers and experienced slow growth and late pubertal development may see the same pattern in their children. The final height these children achieve is usually normal. Parents who have short stature usually have children whose adult height potential is in the shorter range. Conversely, tall parents usually have tall children. As a general rule, a child’s potential adult height ranges between the average of the parents’ heights toward that of the parent who is the same sex as the child.
2. Congenital (those present at birth)
Causes for growth failure include intrauterine growth retardation, skeletal abnormalities, and chromosome changes. Intrauterine growth retardation may result from maternal infections, smoking, or alcohol/drug use while pregnant. Skeletal causes, such as short limb dwarfism, result from abnormal production of new bone and cartilage. These children usually have unusual trunk /limb proportions. Chromosome variations causing short stature can include Turner syndrome in girls and Downs syndrome.
3. Illnesses and Medications
Conditions that are considered chronic can reduce growth because they interfere with the body’s ability to use nutrients properly. Diseases that involve the kidneys, digestive tract, heart, or lungs are examples of such conditions that may influence growth. Some medications that are used in large doses or for long periods of time may affect growth. If you are concerned about the effects of medications on a regular basis, you should discuss this with the physician who prescribed them.
4. Nutritional problems can influence growth in two ways.
More commonly the problem is a poor diet with inadequate nutrients, not enough calories, or the wrong food groups. Secondly, diseases that interfere with the absorption of food from the bowel will prevent the body from using those nutrients for growth. In these cases, symptoms may include nausea, vomiting, excessive gas, diarrhea or constipation, poor weight gain, or being underweight for height. After diagnosis, these problems usually improve with a special diet and or medications. With proper correction of these disorders, growth will also improve.
5. Psycho-social
Situations where a child’s home life is disrupted or unhappy, or where there is a lack of love, consistency, or of emotional support, experience severe stress. This stress can precipitate growth failure. Children’s growth failure from this cause resumes when the problems and stress are gone.
6. Hormones are produced by glands in the body.
After being released from the glands into the blood, the hormones have their effects on many different locations. The most common ones that affect growth are discussed next.
There are also other signs that indicate excessive cortisol such as muscle wasting and weakness, weight gain, easy bruising, and thinning of the skin.
Treatment depends on the cause of the problem.
Children who are above the 95th percentile in height or are growing unusually fast for their age may need to be evaluated by their physician. Most commonly, tall children come from tall families, are growing at the normal rate for their age, and show no signs of ill health. For those children in whom this is not the case, a physical examination and history may reveal the cause. Causes of rapid growth that may be abnormal include excessive growth hormone production, some congenital growth hormone production, some congenital genetic conditions, or early puberty. Signals of these problems may include unusual body proportions, breast growth, enlargement of the genitals, and axillary and pubic hair growth.
What Can You Do?
All children should have records of growth kept with measurements every 3-6 months for infants and yearly for children over 2 years of age. This is usually done at your child’s doctor’s office but you can keep your own records at home.
The best height measurement is done by having the child stand in bare feet against a wall without a baseboard with knees straight, and hips and shoulders touching the wall. Head would be level facing straight ahead. Using a flat object held against the top of the head and touching the wall, you can mark the height of the wall and measure it. Use this method at home and you can suggest that your doctor’s office do the same. This can be done with a device called a “stadiometer” and is more accurate than the measuring device attached to upright scales. Children under 2 years should be measured lying on their backs on a flat surface with a measuring device that has adjustable ends. Each end of the measuring device should fit against the top of the head and soles of the feet with the legs extended. It is acceptable to see a decrease in height when switching from lying to standing measurements (approximately ½ – 1 inch (1.27 cm-2.54 cm).
Ask your child’s doctor to record the measurements on a growth chart. These charts have the normal ranges for U. S. children for height and weight for each age and sex and are divided into percentile patterns. For example, if your child is on the 10th percentile (%), he/she is taller than 10 percent of U.S. children of the same age and sex and shorter than the remaining 90%. The usual range is between the 5th – 95th percentiles.
If your child is below the 5th percentile or above the 95th percentile, your child is not in the appropriate range based on his/her potential from the parents’ heights, your doctor should be concerned and may order other tests. Also, a growth rate that has previously been following along a certain % line and begins to move away either up or down toward another % curve may be cause for more investigation. Typically after age 2 years, a child establishes a set growth pattern along one of the % curves and follows it until growth is completed. Growing away from this percentile may signal a health pIt is essential to understand the various factors that can affect a child's growth, including:
Heredity: A child's growth patterns and height often reflect those of their parents. If parents were late bloomers or had slow growth, their children might follow a similar pattern, ultimately achieving normal height. Short parents tend to have shorter children, while tall parents typically have taller children.
Congenital Factors: Growth failure can result from intrauterine growth retardation, skeletal abnormalities, or chromosome changes. These factors can be influenced by maternal infections, smoking, alcohol or drug use during pregnancy, abnormal bone and cartilage development, or genetic conditions like Turner syndrome or Down syndrome.
Illnesses and Medications: Chronic conditions that interfere with the body's ability to utilize nutrients can affect growth. Examples include diseases involving the kidneys, digestive tract, heart, or lungs. Certain medications, when used in large doses or for extended periods, can also impact growth. Consult with your child's physician if you have concerns about medication side effects.
Nutrition: Poor nutrition can result from inadequate nutrient intake, insufficient calories, or imbalanced food groups. Additionally, diseases that interfere with nutrient absorption from the bowel can prevent the body from using nutrients for growth. Proper diagnosis and treatment can often improve growth once the underlying issue is addressed.
Psychosocial Factors: A disrupted or unhappy home life or lack of emotional support can lead to severe stress, which can negatively affect a child's growth. Growth failure caused by psychosocial factors typically improves when the stress is alleviated.
Hormones: Hormones produced by glands in the body play a crucial role in growth. The most common hormones affecting growth include growth hormone, thyroid hormone, and cortisol. Abnormal levels of these hormones can cause growth disturbances and require medical evaluation.
Monitoring your child's growth is vital for detecting potential health problems. Maintain accurate records and consult with your pediatrician if you notice any significant changes in your child's growth pattern or if they consistently fall outside the typical range. By staying proactive and addressing any concerns early on, you can help ensure your child's continued growth and overall health problem.
There are organizations with information on growth issues throughout the world. Please see the Patient Groups tab (above)/ find your country, and contact the groups for specific assistance or information.
Below are additional resources. Click the topic for more information:
Achondroplasia
Growth Hormone Deficiency
Idiopathic Short Stature
Insulin Like Growth Factor 1 Deficiency
McCune Albright Syndrome
Optic Nerve Hypophasia
Precocious Puberty
Small for Gestational Age
Silver Russell Syndrome also called Russell Silver Syndrome
Thyroid Disorders
Turner Syndrome
Congenital Adrenal Hyperplasia
Excellent growth site with an online growth calculator and additional information provided by Novo Nordisk pharma.
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