| A: Growth is one of the most important aspects of a child’s health. The best tests of normal growth are the child’s rate of growth over time and the child’s height compared to the normal population of the same age and gender. A simple growth chart can graphically track growth rate, as well as weight, over a child’s growing years. An accurate height carefully measured and plotted on a growth chart should be a routine part of every child’s periodic health review.
For example, the normal growth rate for children over the age of 5 years is at least 2 inches per year. If it is less, a consultation with the primary care clinician is needed to see if there is a specific problem accounting for the decreased growth rate.
The normal rate of growth is not always 2 in. per year since it varies by age as follows:
- 10 in. in the first year.
- 4 in the second year.
- 3.5 in. from year 3 to 5.
- 2 in. a year after age 5.
There also may be other important clues that a child is not growing normally:
- No change in shoe or clothing size for the past year.
- Shortest child by far in the class or daycare (of children the same age).
- A “fall off” in the rate of growth at any age.
What does percentile really mean?
If a child were growing at the 5th percentile, that means if we measured 100 boys randomly selected and exactly the same age, the likelihood is that 95 would be taller, and 4 would be shorter. Any height between the 3rd and 97th percentile is considered within the normal range. After the age of 2 years, children have established their own individual percentile. Think of the percentile as a growth channel where a child should remain over time.
If a child is growing at the 20th percentile and falls to the 5th percentile, this is what is meant by fall off. If there is significant crossing of channels in either direction, upward or downward, it means the growth rate is deviating from the child’s normal channel and an evaluation by your clinician is indicated
The 50th percentile is considered average but not everyone is average. Height is like other measurements, namely it varies among the population. No hundred people will have the same height-or pulse, or weight. This is called normal variation. The farther a child is under the 3rd or over the 97th percentile, the greater the likelihood is that there may be a medically relevant reason for the growth pattern so that an evaluation by the primary care clinician is indicated.
| -- Take Home Message -- |
| The height (and weight) should be accurately and carefully plotted on the growth chart as part of all children’s periodic health review. As rule of thumb, if a child is growing less than 2 inches per year (after age 5), an evaluation by the primary care clinician is indicated. Other reasons to discuss a possible growth problem with the clinician include an abnormal rate of growth at any age, a fall off in growth, a height below the 3rd percentile, or any psychological adjustment concerns about a child’s growth. |
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