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Growth Charts: Does My Child Measure Up?

From the moment your child is brought into this world—and every well-check thereafter—they will be measured by their physician. Measured for growth and development, that is.

As a parent, growth charts, and how your child plots along those curves, can bring a bit of anxiety. You may wonder, “Is my child above average or below average?” or “What’s normal or abnormal?”

“Here’s the thing, as a dad of three boys, I too get caught up in asking their weight and height after every child check,” said Michael Bradfield, MD, family physician at Banner Health in Greeley, CO. “Even though I’ve delivered and cared for hundreds of children, I still, as a parent, worry too. I ask, ‘Are they OK?’

For many parents—even physicians like Dr. Bradfield—this anxiety and concern is rooted in the fact that this is one of the few, objective and concrete measures we get about a child’s development.

“While we have concerns, it’s important to remember the real use of these measurements is to look for abnormalities that point to the presence of either nutritional disorders or underlying diseases,” Dr. Bradfield said reassuringly. “These measurements don’t, in themselves, tell a doctor anything, they just help us identify areas where we should ask more questions, monitor more closely and occasionally do workups to make sure the child is growing as well as they can.”

Even knowing this, however, hasn’t stopped parents from keeping a report card along the way. Some parents just want to know whether or not they should worry.

Just like adults, kids come in all shapes and sizes, so how much stock as parents should we put into our child’s growth percentages—or should we just leave these stats to the experts? To answer this question and more, we spoke with Dr. Bradfield.

Where do growth charts even come from?

If you were a baby pre-2000, you may have been a part of the earliest infant growth charts in the U.S. But thanks to a lot of things that happened after Y2K, like updates from the Centers for Disease Control and Prevention (CDC), we have a more inclusive chart that encompasses data from millions of children across the country versus thousands of babies from Yellow Springs, OH.

In 2000, the CDC released growth charts based on millions of children from diverse populations who were both breastfed and bottle-fed. Then in 2006, the World Health Organization (WHO) released international growth charts for children up to 5 years old who were breastfed based on data from communities worldwide.

Today, most doctors use the WHO growth charts for children younger than age 2 and the CDC growth charts for children over age 2.

“While the charts provide framework for us to compare, they certainly aren’t the only things we consider when caring for the health and well-being of children,” Dr. Bradfield said. “It’s important before you interpret numbers to discuss with your child’s doctor.”

How do doctors use growth charts?

The main purpose of growth charts is to help doctors document trends.

The way doctors do this is through height, weight and head measurements. Linear growth is measured as length with your child lying down until 2 years old and then by height in older children. This is used to see how your child's measures deviate from the standard population. Similarly, weight is plotted on a curve versus the standard population.

“Initially we are looking for kids in percentiles less than 3% or greater than 97%,” Dr. Bradfield said. “When children have measurements that fall distinctly from the mean, a doctor will ask more clinical questions to ensure the child is well. As long as they aren’t off the charts, they are probably doing fine.”

Issues with weight and height might be related to low or excess energy intake (meaning too little or too much nutrition). If nutrition is not a problem, then doctors will evaluate underweight, short stature or overweight children. “Usually, these variances turn out to be familial, meaning the genetic makeup of the parents is carried on to the kids,” Dr. Bradfield said. “Most parents of short stature will also have children of short stature, for example.”

When should I get concerned?

First, know this: Unless your child’s doctor has raised concerns, or your child is wildly outside of the “normal range,” you shouldn’t get caught up in the numbers. There are many factors that may contribute to fluctuations in weight and height that aren’t necessarily dangerous or unhealthy.

Oftentimes, weight changes are related to mobility, such as when your child loses weight but starts crawling or transitioning to solid foods. But big changes that are accompanied with a significant growth in weight or height should be a red flag. Don’t be afraid to let your child’s doctor know.

“Parents are the world’s experts when it comes to their own children,” Dr. Bradfield said. “If you notice any changes, whether dramatic or not, it’s OK to have them seen by their doctor for a checkup. A good doctor will be able to help you determine if the changes are normal or not and answer any questions or concerns.”

Outlook

“While it’s fun to track, the actual numbers shouldn’t be your top focus to evaluate your child’s health,” Dr. Bradfield said. “Instead of focusing on percentages on their growth charts, you can focus on their diet, reading to your child and developmental milestones as a good use of your time and energy.”

Do you have questions or concerns about your child’s growth and development? Check out some of these related articles:

Are you new to the area and looking for a pediatrician for your child? Find a Banner Health specialist near you by visiting bannerhealth.com.

Salud del niño Bienestar

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